Bảng Kiểm Học Kĩ Năng Lâm Sàng_yhocthuchanh2015.pdf

D N M - EM

BNG KIM DY/HCK NNG LM SNG

(Dnh cho cc trng i hc Y khoa)CH BIN: PGS. TS. BS. NGUYN VN SN; THS. BS. NG VN HU

C VN CHUYN MN

PGs. Ts. Trn Quc KhamThs. Bs. Nguyn Thanh c

CH BINPGs. Ts. Bs. Nguyn Vn SnThs. Bs. Ng Vn Hu

BAN BIN TP

Ts. Bs. Trnh Vn HngThs. Bs. Ng Vn HuThs. Bs. H Th LThs. Bs. Ng Th Thy NgaPGs. Ts. Bs. Nguyn Vn SnTs. Bs. Hunh Vn Th

THAM GIA BIN SON

Khoa Y Dc - i hc Ty Nguyn

BsCKI. Nguyn Hu ChnhThs. Bs. Ng Th Kim HiThs. Bs. Phan Tn HngThs. Bs. H Th LBsCKI. V Th Kim LoanThs. Bs. Trn i PhcThs. Bs. Vn Hu TiThs. Bs. L B ThanhTs. Bs. Hunh Vn ThThs. Bs. Nguyn Th Xun TrangThs. Bs. Trn Tun Bch Vn

i hc Y Dc Thi Nguyn

Ts. Bs. Trn ChinThs. Bs. L Thu HinBsCKII. Phm Th Qunh HoaTs. Bs. Trnh Vn HngThs. Bs. Hong Th HuThs. Bs. Nguyn Th Xun HngTs. Bs. Phm Kim LinThs. Nng Phng MaiPGs.Ts. Bs. Nguyn Vn SnBsCKII. Nguyn Vn SuTs. Bs. Vi Th Thanh ThyBs. Hong Th Ngc Trm

T chc Pathfi nder International Vit Nam

Ths. Bs. Ng Vn HuCn. L Th Thanh MaiThs. Bs. Ng Th Thy NgaThs. Bi Th Mai Ngn

TH K BIN SON

Cn. Nguyn Th Thanh AnCn. L Th T Anh

5Bng kim dy/hc k nng lm sng

LI GII THIU

Trc yu cu ngy cng cao v cp bch ca nhim v chm sc sc khe nhn dn, vic nng cao cht lng ngun nhn lc y t gi mt v tr then cht. Yu cu quan trng ang t ra i vi vic nng cao cht lng ngun nhn lc y t l cn ch trng c bit ti cng tc i mi o to, c bit l phng php tip cn nng cao k nng v lm sng. Trn c s chun u ra v chng trnh khung o to Bc s a khoa h tp trung 4 nm, trong khun kh ca D n Tng cng chm sc sc khe cho ng bo vng dn tc t ngi thng qua o to ti Vit Nam (D n M - EM), nhm tc gi ca Trng i hc Y Dc Thi Nguyn v Khoa Y Dc - i hc Ty Nguyn bin son cun sch Bng kim dy hc k nng lm sng. Cun sch ra i p ng c yu cu cp thit ca cc c s o to bc s a khoa trong vic dy v hc cc k nng thc hnh lm sng chun.

Cun sch ny l kt qu lm vic nghim tc, y nhit huyt ca cc ging vin giu kinh nghim ca Trng i hc Y Dc Thi Nguyn v Khoa Y Dc - Trng i hc Ty Nguyn vi s h tr k thut ca cc chuyn gia B Y t v T chc Pathfi nder International Vit Nam v s h tr ti chnh ca Qu t thin Atlantic Philanthropies. Vic bin son cun sch ny c thc hin kh bi bn theo ng quy trnh ca vit ti liu dy hc.

Cun sch bao gm 62 bng kim k nng dy/hc lm sng c sp xp mt cch tng i theo cc ch : K nng c bn, Ni khoa, Nhi khoa, Ngoi khoa, Sn-Ph khoa v Truyn nhim. Mi bng kim m t cc bc cn thc hin khi tin hnh mt k nng, ngha v yu cu phi t ca tng bc.

Hy vng cun sch s gip cc ging vin thng nht trong vic dy v lng gi k nng. Sinh vin s dng ti liu ny t hc v hon thin vic thc hnh k nng trn m hnh ti phng thc hnh tin lm sng hay trn ngi bnh. Mc d rt c gng, song cun sch chc chn s khng trnh khi nhng thiu st. Chng ti rt mong nhn c s gp ca ng nghip, bn c cun sch s c hon thin hn trong ln ti bn sau.

Ban bin tp trn trng cm n lnh o Trng i hc Y Dc Thi Nguyn v Khoa Y Dc - Trng i hc Ty Nguyn h tr v to iu kin cc thy c tham gia hot ng D n ni chung v tham gia bin son cun sch ny ni ring. Chng ti trn trng cm n cn b T chc Pathfi nder International Vit Nam v Qu t thin Atlantic Philanthropies h tr k thut v ti chnh cun sch c xut bn v p ng nhu cu dy v hc ca ging vin v sinh vin.

BAN BIN TP

6 Bng kim dy/hc k nng lm sng

DANH MC CC CH VIT TT

Ch vit tt Vit y BTC Bung t cungBPTT Bin php trnh thaiCTC C t cungCSSK Chm sc sc kheCSYT C s y tDCTC Dng c t cungHA Huyt pKCC Kinh cui cngKH Khch hngKHHG K hoch ha gia nhNB Ngi bnhNCBSM Nui con bng sa mNVYT Nhn vin y tTC T cungTHA Tng huyt pTM Tnh mchTSM Tng sinh mn


MC LC

DANH MC CC CH VIT TT .................................................................................................... 6

A - K NNG C BN .......................................................................................................................11

A.1 - BNG KIM K NNG GIAO TIP C BN ................................................................... 12

A.2 - BNG KIM KHAI THC BNH S, TIN S ................................................................ 15

B - NI KHOA ..................................................................................................................................... 17

B.1 - BNG KIM KHM LM SNG H TUN HON ......................................................... 18

B.2 - BNG KIM KHM LM SNG H H HP .................................................................. 21

B.3 - BNG KIM KHM LM SNG H TIT NIU ............................................................. 24

B.4 - BNG KIM T VN NGI BNH TIU NG ....................................................... 26

B.5 - BNG KIM T VN NGI BNH TNG HUYT P ................................................ 29

B.6 - BNG KIM KHM LM SNG TUYN GIP ............................................................... 33

B.7 - BNG KIM KHM NGI BNH HN M ................................................................... 36

B.8 - BNG KIM KHM VN NG ....................................................................................... 39

B.9 - BNG KIM KHM THC TH C XNG KHP ....................................................... 42

B.10 - BNG KIM KHM 12 I DY THN KINH S NO .............................................. 47

B.11 - BNG KIM KHM CM GIC ....................................................................................... 52

B.12 - BNG KIM KHM HI CHNG MNG NO ............................................................. 54

B.13 - BNG KIM KHM PHN X ......................................................................................... 57

C - NHI KHOA..................................................................................................................................... 61

C.1 - BNG KIM T VN NUI CON BNG SA M .......................................................... 62

C.2 - BNG KIM NH GI TUI THAI TR S SINH ........................................................ 65

C.3 - BNG NH GI TUI THAI CA FINSTROM (bng tham chiu) ................................ 66

C.4 - BNG KIM HI SC TR S SINH ................................................................................. 67

C.5 - BNG KIM KHM DA, C, XNG TR EM ............................................................... 72

C.6 - BNG KIM KHM V NH GI TNH TRNG MT NC ................................... 74

C.7 - BNG KIM PHA ORESOL (ORS) ...................................................................................... 76

C.8 - BNG KIM CHO NGI BNH TH OXY ..................................................................... 78

C.9 - BNG KIM CHO NGI BNH N QUA SONDE D DY ......................................... 80

D - NGOI KHOA............................................................................................................................... 83

D.1 - BNG KIM KHM LM SNG BNG ................................................................................................. 84


D.2 - BNG KIM KHM LM SNG VIM PHC MC ....................................................... 86

D.3 - BNG KIM KHM LM SNG HI CHNG TC RUT ........................................... 88

D.4 - BNG KIM KHM LM SNG CHN THNG S NO .................................................................90

D.5 - BNG KIM KHM LM SNG CHN THNG NGC ............................................. 92

D.6 - BNG KIM S CU GY XNG H ........................................................................... 95

D.7 - BNG KIM S CU CHN THNG NGC H ......................................................... 97

D.8 - BNG KIM KHM LM SNG GY XNG KN ................................................................99

D.9 - BNG KIM S CU GY KN XNG CNH TAY ................................................... 101

D.10 - BNG KIM S CU GY KN XNG CNG TAY ................................................. 103

D.11 - BNG KIM S CU GY KN XNG I .............................................................. 105

D.12 - BNG KIM S CU GY KN XNG CNG CHN ............................................. 107

D.13 - BNG KIM S CU GY KN XNG N ............................................................ 109

D.14 - BNG KIM KHM LM SNG TRT KHP ............................................................................111

D.15 - BNG KIM X TR VT THNG PHN MM N GIN N SM .................113

D.16 - BNG KIM CT ON RUT, KHU NI RUT TN - TN ................................115

D.17 - BNG KIM M BNG THEO NG TRNG GIA TRN RN ..........................117

D.18 - BNG KIM NG THNH BNG HAI LP ...............................................................119

D.19 - BNG KIM K NNG THM D D DY - RUT ................................................. 121

D.20 - BNG KIM KHU L THNG NH D DY ........................................................... 123

D.21 - BNG KIM CHC D TY SNG ............................................................................... 124

E - SN PH KHOA ...................................................................................................................... 127

E.1 - BNG KIM KHM THAI ................................................................................................. 128

E.2 - BNG KIM NGHE TIM THAI BNG NG NGHE G ................................................. 131

E.3 - BNG KIM S NN NGOI XC NH T TH THAI NHI VI THAI TRN 28 TUN ................................................................................................. 133

E.4 - BNG KIM O CN CO T CUNG BNG TAY KHI CHUYN D .......................... 135

E.5 - BNG KIM THEO DI CHUYN D BNG BIU ............................................... 136

E.6 - BNG KIM THNG NGI CHM .................................................................. 139

E.7 - BNG KIM X TR TCH CC GIAI ON 3 CA CHUYN D V KIM TRA BNH RAU ................................................................................................ 142

E.8 - BNG KIM CT KHU TNG SINH MN ................................................................ 145

E.9 - BNG KIM KHM V CHM SC TR S SINH NGAY SAU ................................... 148

E.10 - BNG KIM KHM V ................................................................................................... 152

E.11 - BNG KIM HNG DN T KHM V ................................................................... 154

E.12 - BNG KIM KHM PH KHOA .................................................................................... 156

E.13 - BNG KIM T VN K HOCH HA GIA NH ..................................................... 158

E.14 - BNG KIM T DNG C T CUNG LOI TCu 380A ............................................ 161


E.15 - BNG KIM HT THAI DI 7 TUN BNG BM HT CHN KHNG .............. 163

E.16 - BNG KIM LY BNH PHM LM T BO M O ........................................... 166

F - TRUYN NHIM ........................................................................................................................ 169

F.1 - BNG KIM T VN CHO NGI B NHIM HIV/AIDS ............................................ 170

PH LC ............................................................................................................................................ 174

TRANG B THIT YU V SC KHE SINH SN CHO MT TRM Y T X ................. 174

TI LIU THAM KHO ................................................................................................................. 178


a

A - K NNG C BN


A.1 - BNG KIM K NNG GIAO TIP C BN

TT CC BC NGHA YU CU CN TCHUN B

1. NVYT mang trang phc theo quy nh ca CSYT.

To hnh nh NVYT chuyn nghip vi KH.

Trang phc theo ng quy nh ca CSYT.

2. Chun b cc ti liu, phng tin truyn thng t vn cn thit.

Gip tng thm hiu qu giao tip.

Ph hp vi mc ch giao tip ca NVYT.

THC HINGii thiu

3. - NVYT cho hi KH khi gp g, mi KH ngi ngang hng;

- T gii thiu tn, chc danh, nhim v ti CSYT.

To s thn thin, thoi mi, tin cy vi KH.

KH bit c th NVYT m mnh ang tip xc.

4. To mi trng thch hp, thn thin, thong mt, nh sng v m bo ring t khi KH chia s cc thng tin c nhn.

H tr giao tip hiu qu.

Mi trng giao tip bo m s thoi mi, ring t cho KH.

t cu hi5. Hi nhng thng tin lin quan

n th tc hnh chnh ca KH n khm hoc ang c chm sc, iu tr ti c s y t.

Thu nhn thng tin ghi h s KH.

y , chnh xc theo yu cu.

6. Thu thp thng tin v cc vn sc khe hin ti ca KH.

Thu thp c chnh xc cc vn sc khe hin ti ca KH.

- S dng cu hi m, ng, mt cch a dng v hp l, d hiu v ph hp vi trnh nhn thc, tui tc, gii tnh ca KH v ph hp vi vn ha vng min;

- S dng cu hi ng kim chng li thng tin nu cn (... c phi khng? hoc... c ng khng?).

7. Thu thp cc thng tin lin quan n vn sc khe hin ti ca KH: Thi im xut hin (cc triu chng c nng v thc th), mc v din bin, cc bin php c p

Thu thp chnh xc v khch quan cc thng tin lin quan n din bin cc vn sc khe ca KH.

- S dng cc cu hi m (khi no? tnh cht v din bin ra sao?...) v cc cu hi ng (c/khng?... phi khng?... c ng khng?...) mt cch a dng v hp l,


K nng c bn

TT CC BC NGHA YU CU CN Tdng trc gii quyt cc vn sc khe ca KH?

d hiu v ph hp vi nhn thc, tui, gii tnh ca KH v ph hp vi vn ha vng min thu thp v kim chng thng tin.

8. Thu thp cc thng tin v tin s bn thn v tin s gia nh lin quan n vn sc khe hin ti ca KH.

Thu thp chnh xc v khch quan cc thng tin ca bn thn v gia nh KH c lin quan n vn sc khe hin ti ca KH.

- S dng cu hi m (c bao gi mc khng? C ai b bnh nh vy khng? Mi trng xung quanh ra sao?...) v cc cu hi ng (c/khng?... phi khng? c ng khng?...), mt cch a dng v hp l, d hiu v ph hp vi nhn thc, tui, gii tnh ca KH v ph hp vi vn ha vng min thu thp v kim chng thng tin.

9. S dng hiu qu cc k nng lng nghe trong qu trnh giao tip.

Khuyn khch KH ni ht nhng thng tin cn cho vic khm, chn on, iu tr v chm sc KH.

p dng hiu qu cc k nng lng nghe trong sut qu trnh giao tip vi KH:- Giao tip bng nh mt,

c ch, nt mt, iu b th hin s sn sng quan tm v chia s nhng iu KH ang cp;

- Thm cc t m (, , vng) hoc t cu hi hp l th hin s quan tm v khuyn khch KH chia s ht nhng vn lin quan n tnh trng sc khe ca h;

- Hn ch ngt li KH, khng lm vic khc trong khi nghe KH ni;

- Ghi nh c cc chnh KH cp.


TT CC BC NGHA YU CU CN T10. S dng hiu qu k nng trnh

by - Ni r rng, nhanh va phi;- Dng i t nhn xng v cc

t ng trong giao tip ph hp vi tui, gii v vn ha vng min;

- Phi hp dng ngn ng khng li ph hp: th hin s ng cm, nh mt, n ci v khuyn khch KH chia s suy ngh v lo lng ca h.

Khng nh cc thng tin thu c t KH v cung cp cc thng tin lin quan n tnh trng sc khe ca KH.

- Kt hp hi ha cc ngn ng c li v khng li trong sut qu trnh giao tip, tp trung vo vn sc khe hin ti ca KH;

- m bo KH hiu ng nhng g NVYT ni v tng tc hai chiu vi NVYT.

11. S dng hiu qu k nng phn hi tch cc- Khen ngi kp thi khi KH c

kin thc/thi /thc hnh ng;

- Tr li cc cu hi ca KH, gip h hiu c nguyn nhn cc vn sc khe hin ti;

- a ra cc li khuyn khch quan, ph hp thc t KH ra quyt nh gii quyt vn sc khe ca bn thn;

- Tn trng cc thi quen, phong tc tp qun khng c hi cho sc khe ca KH; kin tr hng dn, t vn KH thay i nhng thi quen c hi cho sc khe.

KH bit c vn sc khe v hng gii quyt tip theo.

KH bit c vn sc khe ca bn thn, hng x tr tip theo ti CSYT v bit cch phi hp vi NVYT trong qu trnh chm sc v iu tr tip theo.


K nng c bn

A.2 - BNG KIM KHAI THC BNH S, TIN S

TT CC BC NGHA YU CU CN T

CHUN B1. Phng tin

- H s bnh n, s khm bnh;- Bt.

To thun li cho vic hi bnh v lm bnh n.

Chun b h s bnh n, s sch ph hp vi quy nh chuyn mn.

2. NVYT mang trang phc theo quy nh.

m bo quy nh ca CSYT.

3. Ngi bnh hoc ngi nh sn sng.

THC HIN

4. NVYT cho hi NB v ngi nh, t gii thiu tn, nhim v ca NVYT ti c s.

To c mi quan h thn thin vi NB.

Theo ng phong tc, tp qun ca vng min, gii thiu r rng v th hin thi sn sng gip NB.

5. Hi v cc thng tin hnh chnh.

Gip thu thp cc thng tin hnh chnh lin quan n NB.

- Hi y cc mc hnh chnh theo quy nh ca h s bnh n;

- S dng hp l cc cu hi m v cu hi ng thu c thng tin y , chnh xc.

6. Hi l do NB n CSYT. Xc nh c vn sc khe chnh ca NB, gip NVYT nh hng hi tip cc thng tin lin quan n bnh s v tin s bnh.

Xc nh c l do NB n CSYT.

7. Hi bnh s - Triu chng u tin ca bnh?

Hon cnh xut hin?- Din bin cc triu chng;- Cc triu chng i km v din

bin cc triu chng ;- iu tr g cha? u? iu tr nh th no v kt qu ca iu tr?

Thu thp c cc thng tin gip chn on bnh.

- Dng cu hi m/ng ph hp khai thc v khng nh c s xut hin v qu trnh din bin cc vn sc khe ca NB tnh n thi im tip xc;

- S dng ngn ng khng li v c li mt cch hiu qu;



- C c bnh s NB y v chnh xc.

- Tnh trng n, ng, i tiu, i tiu nh th no?

- Tnh trng hin nay ca NB (hi cc triu chng c nng).

8. Hi tin s bnh- Bn thn NB: b bnh nh

th ny bao gi cha? Nu c th c chn on v iu tr nh th no?

- Cc bnh khc mc trc ? iu tr nh th no? Tnh trng bnh hin nay?

- Gia nh: c ai mc bnh tng t khng?

H tr chn on xc nh, chn on phn bit v tin lng bnh.

- Xc nh c tin s cc bnh tt c lin quan ca NB v gia nh;

- Vn dng hiu qu cc ngn ng khng li v c li;

- Tn trng cc thi quen v phong tc tp qun ca NB khng c hi cho sc khe.

9. Hi v dch t hc- Hi v tnh trng bnh ca

nhng ngi xung quanh trong cng ng?

- Hi v iu kin v sinh mi trng, tin s chng nga?

- Hi v nhng bnh dch ang lu hnh ti ni NB ang sinh sng?

Gip tm hiu cc bnh dch ti cng ng v nh hng yu t nguy c gy bnh.

- Khai thc y cc yu t vn ha phong tc tp qun nh hng n vn sc khe ca NB v cng ng NB sinh sng;

- Xc nh c cc dch bnh hin c ti khu vc NB sinh sng;

- Nhn bit cc yu t nguy c ca bnh.

10. Tng hp cc thng tin hi v ngh NB xc nhn li trc khi ghi vo h s bnh n.

Gip khng nh li thng tin cho chnh xc.

Thng tin v bnh s v tin s thu c l chnh xc v y .

11. Ghi bnh s, tin s vo h s bnh n v bt u khm bnh.

Hon chnh h s bnh n.

- Hon thin cc mc theo quy nh ca bnh n;

- Thc hin khm bnh theo cc bng kim lin quan.

B - NI KHOA


B.1 - BNG KIM KHM LM SNG H TUN HON


CHUN B1. - Dng c: ng nghe, huyt p

k, nhit k, ng h bm giy;- Ni khm: c bn khm/ging

khm sch s, nh sng v m bo ring t cho NB;

- NVYT mang trang phc theo quy nh, ra tay thng quy;

- NB: ngh ngi khong 15 pht trc khi khm.

- Gip thc hin thm khm tim mch c thun li;

- Khng ch nhim khun trong qu trnh khm bnh.

- Dng c khm , ph hp vi NB (ngi ln/tr em) v sn sng s dng;

- Ra tay theo quy trnh.

THC HIN2. NVYT cho hi NB/ngi nh,

t gii thiu tn v nhim v ti CSYT, hi l do NB n CSYT, gii thch vi NB v quy trnh khm v hng dn NB/ngi nh nhng iu cn thit h hp tc.

To tm l tt cho NB.

- NB thoi mi v yn tm hp tc trong qu trnh khm;

- NVYT th hin thi sn sng h tr NB.

3. Hi bnh- L do n CSYT;- Bnh s: ch n cc triu

chng c nng nh kh th, au ngc, mt mi, v.v iu tr g trc khi n CSYT?

- Tin s bnh lin quan ca bn thn NB v gia nh (tim mch, tng huyt p, tiu ng, bnh h hp)?

Gip nh hng cho khm thc th thun li.

Thu thp c y v chnh xc thng tin v l do NB n khm, bnh s v tin s lin quan.

4. Khm ton thn - Trng thi tinh thn ca NB;- Cc biu hin ca ph v tnh

cht ph;- Th trng, da, nim mc, u chi;- Du hiu sinh tn


Pht hin c cc triu chng ton thn lin quan n cc bnh tim mch.

5. Khm tim mchT th NB: nm nga, nghing sang tri hoc ngi; bc l vng trc tim.

Thun li cho vic thm khm.

- NB t th ph hp, bc l vng cn khm;

- NVYT m bo quyn c ring t ca NB.


Ni khoa


6. Nhn lng ngc- Hnh dng lng ngc;- V tr mm tim p;- Tnh mch c;- Tun hon bng h.

nh gi s b v tr v cng p ca mm tim, tnh mch c v tun hon bng h.

- Xc nh c hnh dng lng ngc bnh thng hay bt thng;

- Xc nh c v tr mm tim;

- TM c c r khng, c tun hon bng h khng.

7. S vng trc tim- Xc nh v tr v cng p

ca mm tim;- Xc nh rung miu.

nh gi v tr v cng p ca mm tim, rung miu.

- Xc nh c v tr v cng p ca mm tim;

- Xc nh c rung miu khng?

8. G din c ca tim- Din c tng i;- Din c tuyt i.

Xc nh kch thc tng i ca tim.

- G ng k thut: g gin tip ln thnh ngc NB qua ngn tay ca NVYT;

- Xc nh c din c ca tim bnh thng hay bt thng.

9. Nghe ting tim- Xc nh 5 v tr nghe tim;

Thc hin nghe ti 5 v tr, nhn nh: Nhp u hay khng u? Tn s? Ting T1 v T2? C ting bt thng khng? Nu c th l ting g v tnh cht ca n nh th no?

Xc nh ting tim bnh thng hay bt thng.

- Nghe 5 v tr;- Xc nh v m t ng v y c im cc ting tim.

10. Khm ng mch ngoi bin- Khm tnh cht ng mch

ngoi bin: tn s, nhp iu, bin v n hi ng mch;

- o huyt p ng mch.

nh gi tnh trng ng mch ngoi bin.

- Khm ng k thut;- M t c tnh cht ng

mch, huyt p ng mch; - Xc nh ng x va,

hp, vim tc ng mch ngoi bin.

11. Khm tnh mch ngoi bin- Khm tnh mch c;- Khm tun hon bng h;- Khm gin, vim tc tnh mch

ngoi bin.

nh gi tnh trng tnh mch ngoi bin.

- Khm ng k thut;- Xc nh c hoc khng

c tnh mch c ni; tun hon bng h; gin tnh mch, vim tc tnh mch.



12. Kt thc khm- Thu dn dng c;- Gip NB tr v t th thoi

mi, thng bo s b kt qu thm khm v t vn hng x tr tip theo;

- Cho v cm n NB;- Ghi vo h s bnh n.

- NB bit c tnh trng bnh hin ti v yn tm hp tc trong chn on v iu tr;

- nh hng phng php iu tr tip theo;

- m bo nguyn tc ghi h s bnh n ca CSYT.

- Thu dn dng c gn gng;

- NB c thng tin r rng v tnh trng bnh hin ti;

- xut hng x tr tip theo hp l;

- NVYT th hin thi thng cm, sn sng gip NB;

- Ghi h s bnh n r rng v y .


Ni khoa

B.2 - BNG KIM KHM LM SNG H H HP


1. - Dng c: ng nghe, huyt p k, nhit k, ng h bm giy;

- Ni khm: C bn khm/ging khm sch s, nh sng v m bo ring t cho NB;

- NVYT mang trang phc theo quy nh, ra tay thng quy;

- NB: c ngh ngi khong 15 pht trc khi khm.

- Gip thc hin thm khm c thun li;


- Dng c khm , ph hp vi NB (ngi ln/tr em) v sn sng s dng;


THC HIN

2. NVYT cho hi NB/ngi nh; T gii thiu tn v nhim v ti CSYT.

To tm l tt cho NB.


- NVYT th hin thi sn sng h tr NB.

3. Hi bnh- L do n CSYT;- Bnh s: ch nhng triu

chng c nng nh ho, st, kh th, au ngc; nhng thuc iu tr;

- Tin s bnh lin quan ca bn thn NB v gia nh?

- Dch t hc: Tnh trng bnh/dch ca nhng ngi xung quanh trong gia nh v cng ng, tin s chng nga ca bn thn?

Thu thp thng tin gip nh hng cho khm thc th thun li.

Hi c bnh s, tin s NB v dch t hc mt cch y v chnh xc.

4. Khm ton thn- Trng thi thn kinh: tnh to,

li b, hoc vt v kch thch?- Th trng, da, mi, nim mc, u chi (mu sc v hnh dng ngn - di trng?);

- Cc du hiu sinh tn: mch, nhit , huyt p.

Gip nh hng cho khm thc th b phn.

Pht hin c cc triu chng ton thn lin quan n cc bnh phi.


TT CC BC NGHA YU CU CN TKhm h hp

5. T th NB - Ngi t th ngh ngi, vn o

bc l na trn ca c th, th u bng mi.

Khm trc ngc v lng: 2 tay bung thng.

Khm vng nch v mng sn: 2 tay m sau gy.

- Trong trng hp NB mt c th khm bnh t th NB nm nga v nm nghing.

To t th thun li nht cho vic khm bnh.

NB c t ng t th khm bnh, cc c khng co cng, khng th bng ming.

6. Nhn - Hnh dng ca lng ngc;- Hot ng ca c h hp v di

chuyn ca lng ngc khi th;- m v nhn xt c tn s,

bin , kiu th (nhanh, chm, nng, su, kiu Kussmaul).

Pht hin c vn lng ngc bnh thng/bt thng.

- Nhn nh ng hnh dng lng ngc, hot ng c h hp;

- nh gi chnh xc nhp th, kiu th.

7. S lng ngc- nh gi thnh ngc: s ln

lt t trn xung, t trong ra ngoi, i xng 2 bn;

- nh gi rung thanh: hng dn c NB m 1, 2, 3 trm to di, t 2 lng bn tay p st thnh ngc, s ln lt t trn xung di, i xng 2 bn;

- S hch ti cc v tr: thng n, 2 bn c, nch.

- Xc nh cc c im thnh ngc bnh thng/bt thng;

- Xc nh tnh dn truyn thanh m qua thnh ngc.

- S ng k thut, lng bn tay p st vo thnh ngc NB;

- M t c cc du hiu rung thanh (bnh thng, tng, gim);

- Xc nh ng v tr v tnh cht ca hch trn NB.

8. G - Ngn gia tay tri NVYT cng

lm m t p st vo thnh ngc NB, ngn tay 3 ca tay phi NVYT g ln ngn m bng lc c tay;

- G i xng t trn xung di theo ng dch dc, i xng hai bn.

nh gi tnh trng trong/c/vang ca trng phi.

- G ng k thut, khng b st. Khng g trn xng b vai;

- Nhn nh chnh xc trng phi bnh thng/ c/vang.


Ni khoa

TT CC BC NGHA YU CU CN T9. Nghe

- Nghe i xng t trn xung di, pha trc, sau, v 2 bn ngc, khng nghe trn xng b vai;

- t ng nghe vo v tr cn nghe, p st ng nghe vo thnh ngc NB, dn NB th u, su qua ng mi;

- Nghe 2 th h hp; - NB th su, u ( tr nh c

g ng nghe khi tr v a h t kh c, tr s th v o su).

nh gi c im r ro ph nang v cc ting bt thng phi.

- Nhn nh c r ro ph nang (bnh thng, gim, vng th b);

- Xc nh ng cc ting bnh l (ran, thi, c).

10. Kt thc khm- Thu dn dng c;- Gip NB tr v t th thoi

mi, thng bo s b kt qu thm khm v t vn hng x tr tip theo;


- NB bit c tnh trng bnh hin ti v yn tm hp tc trong chn on v iu tr;

- nh hng phng php iu tr tip theo;

- m bo nguyn tc ghi h s bnh n ca CSYT.


- NB c thng tin r rng v tnh trng bnh hin ti;

- xut hng x tr tip theo hp l;

- NVYT th hin thi thng cm, sn sng gip NB;

- Ghi bnh n r rng v y .


B.3 - BNG KIM KHM LM SNG H TIT NIU

TT CC BC NGHA YU CU CN T1. Chun b

- Dng c: gng tay, ng nghe;- Ni khm: C ging khm sch

s, nh sng v m bo ring t cho NB;

- NVYT: trang phc ng quy nh, ra tay; cho hi, gii thch cho NB v quy trnh cc bc khm;

- T th NB: nm nga thoi mi, chng hai chn lm trng c bng, bc l vng cn khm.

To tm l tt cho NB, gip thc hin thm khm c thun li.

- dng c khm;- NB thoi mi, yn tm

hp tc trong qu trnh khm.

2. Hi bnh- L do NB n CSYT;- Bnh s;- Tin s bn thn v gia nh.

Gip nh hng chn on v tin lng.

Thu thp y thng tin v bnh s, tin s.

3. Khm ton thn- Tri gic;- Th trng, mu sc da, nim mc; - Lu khm ph: v tr v tnh

cht ph; - o cc du hiu sinh tn.

Pht hin cc du hiu bt thng ton thn gip chn on v tin lng bnh.

Khm ng k thut v nh gi ng kt qu khm ton thn.

4. Khm thn- Nhn vng h tht lng hai bn;- S: nghim php chm thn v

nghim php bp bnh thn;- G rung thn;- Nghe ng mch thn.

Gip chn on v tin lng bnh.

- Khm ng k thut;- Xc nh c cc triu

chng.

5. Khm cc im au niu qun- im niu qun trn;- im niu qun gia.

Pht hin cc im au niu qun.

- Khm ng cc bc (theo quy trnh khm niu qun);

- Tr li kt qu: c im au niu qun khng?

6. Khm bng quang (nhn, s, g) Xc nh bng quang c cng hay khng?

Khm ng cc bc. Tr li chnh xc kt qu: c cu bng quang khng?


Ni khoa

TT CC BC NGHA YU CU CN T7. Khm niu o

- Nhn l ngoi niu o, quan st: ty , lot ming so, c m chy ra?

- S: vut dc niu o (nam). ph n, dng 2 ngn tay vch hai mi ln v nh.

Xc nh bt thng niu o.

- Khm ng phng php;- Kt qu: c hp bao quy u? C vim ty hoc chy m khng? C si niu o khng?

8. Khm tin lit tuyn (nam)Thm khm qua trc trng. Xc nh cc du

hiu bt thng ca tin lit tuyn.

- Khm ng phng php;- Kt qu: tin lit tuyn bnh

thng hay bt thng?9. Kt thc khm

- Thu dn dng c;- Gip NB tr v t th thoi mi;- Thng bo kt qu khm cho

NB/ngi nh v hng x tr tip theo;


NB c thng tin v tnh trng bnh, yn tm v tin tng tip tc phi hp trong chn on v iu tr.

- Thu dn dng c gn gng;- Ghi h s bnh n r rng,

chnh xc v y ;- xut cc bc tip theo.


B.4 - BNG KIM T VN NGI BNH TIU NG


1. - Ni t vn: sch s, thong mt, c bn gh, t ngi qua li;

- Phng tin ti liu truyn thng t vn: ph hp vi ch tiu ng.

To s thoi mi v quyn ring t ca KH khi t vn.

- Ni t vn m bo khng c ngi ra vo, nghe thy cc thng tin khi t vn;

- Ti liu truyn thng ph hp vi KH c t vn.

2. Ngi t vn mang trang phc ph hp vi quy nh ca c s t vn.

To s tin tng ca KH vi cuc t vn.

Tun th quy nh v trang phc ca c s t vn.

THC HIN G1 - Gp g

3. - Tip n, cho hi KH;- Mi KH ngi ngang hng;- NVYT t gii thiu tn, chc

danh v nhim v ti CSYT.

gy thin cm v to s yn tm vi KH.

- Ph hp vi tui, gii, dn tc v vn ha vng min;

- Thi thn thin sn sng gip KH.

G2 - Gi hi4. - Hi tn, tui, a ch KH;

- L do KH mun c t vn;- Nhng bn khon ca KH v

bnh tiu ng; - Cc tin s v bnh s c lin

quan n tiu ng;- Ch iu tr v chm sc lin

quan m KH p dng.

Xc nh nhng vn cn h tr ca KH trong CSSK.

- S dng linh hot v hiu qu cc cu hi ng/m thu thp y cc thng tin t KH;

- S dng ngn ng d hiu, thng dng, ph hp vi vn ha vng min;

- Tn trng cc hnh vi, phong tc tp qun khng c hi cho sc khe ca KH.

5. Gi hi nhng kin thc ca KH v bnh tiu ng:- Cc biu hin thng gp; - Cc bin chng c th gp v

du hiu;- Cc loi thuc h ng huyt:

cch s dng, bo qun, thuc Insulin;

- Ch n, ch tp luyn vi ngi b tiu ng;

- Ch khm bnh v ti khm.

Xc nh nhng thiu ht v v kin thc v k nng ca KH.

- S dng linh hot cc cu hi m/ng;

- S dng ngn ng d hiu, thng dng, ph hp vi vn ha vng min;

- Khuyn khch KH chia s cc quan nim, hiu bit, thc hnh ca bn thn v cng ng trong chm sc v iu tr tiu ng, khng ph phn, p t.


Ni khoa

TT CC BC NGHA YU CU CN TG3 - Gii thiu

6. Gii thiu s lc v bnh tiu ng, c s dng ti liu ph hp:- Nguyn nhn, triu chng;- Nhng loi thuc iu tr hin

c ti th trng, cch s dng;- Mc tiu iu tr tiu ng;- Cch chm sc NB mc tiu ng;

- Cc bin chng c th gp ca tiu ng v cch hn ch phng nga.

Gip KH hiu v nguyn nhn bnh, mt s thuc thng dng v cch phng bin chng.

- KH bit s dng mt s loi thuc thng dng trn th trng;

- KH bit cch chm sc khi mc tiu ng, bit nhn din sm bin chng x tr kp thi;

- NVYT khng th hin cc thi p t hoc thin lch khi gii thiu cc thng tin cho KH.

G4 - Gip 7. - Cung cp kin thc v tiu

ng m KH cn thiu hoc hiu cha ng;

- Hng dn KH thc hnh cc k nng cha bit hoc lm cha ng:

Cch ung thuc, cch tim Insulin;

Ch n; Ch luyn tp; Cch th ng huyt nhanh

(nu c); Cn dn cc du hiu nguy him

cn n ngay c s y t.

Gip KH hon thin hn v kin thc, k nng t chm sc bn thn.

- Cung cp y cc thng tin cn thiu ph hp vi trnh hiu bit ca KH;

- KH t ln k hoch tun th iu tr v chm sc bn thn mt cch kh thi nht v hiu qu nht;

- Tn trng v pht huy cc yu t vn ha, thi quen v phong tc tp qun c li cho sc khe ca KH.

G5 - Gii thch8. Gii thch tm quan trng v

nh hng ca bnh i vi cht lng cuc sng:- Din bin v tin trin ca bnh;- Bin chng c th c;- Kh nng kim sot c bnh.

Gip KH c thi tch cc hn trong chm sc v iu tr tiu ng.

Cung cp y thng tin v din bin, bin chng cho KH v cch kim sot KH hiu, yn tm iu tr v thc hnh chm sc hp l.

9. Khuyn khch KH hi v chia s nhng iu KH cn bn khon thc mc, tr li cc cu hi ca KH.

m bo KH hiu ng v bnh tiu ng, tun th ng cch iu tr v chm sc bn thn.

KH tha mn cc cu tr li ca ngi t vn.


TT CC BC NGHA YU CU CN TG6 - Gp li

10. ngh KH nhc li mt s im chnh cp trong cuc t vn.

Xc nh li mc tip nhn thng tin ca KH.

KH nhc li nhng thng tin chnh cn ghi nh v thc hin sau cuc t vn.

11. - T vn KH v lch ti khm;- Khuyn khch KH gp li khi

cn v th hin thi sn sng h tr KH;

- Cung cp cc ti liu truyn thng ph hp vi KH;

- Cm n v cho tm bit KH.

Th hin s tn trng, quan tm ti KH.

KH bit r lch ti khm: u, khi no v cn mang theo nhng g?

12. Ghi chp h s s sch. m bo quy nh ca CSYT.

Cc thng tin theo quy nh c ghi chp y , chnh xc.


Ni khoa

B.5 - BNG KIM T VN NGI BNH TNG HUYT P


1. - Ni t vn: sch s, thong mt, c bn gh, t ngi qua li;

- Phng tin ti liu truyn thng t vn: ph hp vi ch tng HA.

To s thoi mi v quyn ring t ca KH khi t vn.

- Ni t vn m bo khng c ngi ra vo, nghe thy cc thng tin khi t vn;

- Ti liu truyn thng ph hp vi KH c t vn.

2. - Ngi t vn: kin thc v k nng t vn

v tng huyt p; Mang trang phc ph hp vi

quy nh ca c s y t.

To s tin tng ca KH vi cuc t vn.

- Cung cp cc thng tin chnh xc cho KH trong qu trnh t vn;

- Tun th quy nh v trang phc.

THC HIN G1 - Gp g

3. - Tip n, cho hi KH;- Mi KH ngi ngang hng;- T gii thiu v mnh v nhim

v ti CSYT.

gy thin cm v to s yn tm vi KH.

- Ph hp vi tui, gii, dn tc v vn ha vng min;

- Th hin c thi thn thin sn sng gip KH.

G2 - Gi hi4. - Hi tn, tui, a ch KH;

- L do KH mun c t vn;- Cc lo lng bn khon ca KH; - Cc tin s v bnh s c lin

quan;- Cc ch iu tr bnh v ch chm sc m trc KH p dng.

Xc nh nhng vn cn h tr ca KH trong CSSK.

- S dng linh hot v hiu qu cc cu hi ng/m thu thp y cc thng tin t ngi bnh;

- S dng ngn ng (khng li v c li) d hiu, thng dng, ph hp vi vn ha vng min;

- Tn trng cc hnh vi, phong tc tp qun khng c hi cho sc khe ca KH.

5. - Gi hi nhng kin thc v thc hnh ca KH v tng huyt p;

- Nhng lo lng v vn m KH quan tm.

Xc nh nhng thiu ht v kin thc v k nng ca KH.

- S dng linh hot v hiu qu cc cu hi ng/m thu thp y cc thng tin t ngi bnh;

- S dng ngn ng (khng li v c li) d hiu, thng dng, ph hp vi vn ha vng min;


TT CC BC NGHA YU CU CN T- Khuyn khch KH chia s

cc quan nim, hiu bit, thc hnh trong chm sc v iu tr THA.

G3 - Gii thiu6. Gii thiu s lc v bnh THA

- Khi nim v bnh v cc triu chng;

- Mc tiu iu tr THA v ch chm sc;

- Cc bin chng c th gp ca THA v cch phng nga.

Gip KH hiu bit s lc v bnh THA.

- KH c cung cp cc thng tin, kin thc chnh xc lin quan n THA;

- NVYT khng th hin cc thi p t hoc thin lch khi gii thiu cc thng tin cho KH.

G4 - Gip 7. Gip KH hiu nhng nguyn

nhn gy THA- Phn ln (>90%) l khng r

nguyn nhn;-


Ni khoa

TT CC BC NGHA YU CU CN T10. Gip KH hiu nhng bin chng

ca THA- Tim: au tc ngc, nhi mu c

tim, suy tim;- Mt: gim th lc, m mt, xut

huyt gic mc;- No: tai bin mch mu no;- Thn: protein niu, suy thn.

Gip KH nhn bit cc bin chng c th xy ra do THA.

- T vn r rng, d hiu;- KH bit c bin chng

c th gp do THA.

11. Gip KH hiu mc tiu iu tr THA- Kim sot con s HA:


TT CC BC NGHA YU CU CN T14. Gii thch cho KH cch theo di

v ti khm- Theo di HA trong qu trnh iu tr v cc du hiu sm ca bin chng THA;

- Ti khm nh k;- Nhp vin khi c du hiu nng

ca THA: con s HA qu cao, xy ra bin chng THA.

Gip KH bit cch t theo di bnh THA v ti khm, nhp vin khi cn thit.

- T vn r rng, d hiu;- KH bit cch t theo di

bnh THA v ti khm, nhp vin khi cn thit.

G6 - Gp li15. ngh KH nhc li mt s im

chnh cp trong cuc t vn. Xc nh li mc tip nhn thng tin ca KH.

KH nhc li nhng thng tin chnh cn ghi nh v thc hin sau cuc t vn.

16. - T vn KH v lch ti khm;- Khuyn khch KH gp li khi

cn, v th hin thi sn sng h tr KH;

- Cm n v cho tm bit KH.

Th hin s tn trng, quan tm ti KH.

KH bit r lch ti khm: u, khi no v cn mang theo nhng g?

17. Ghi chp h s s sch. m bo quy nh ca CSYT.

Cc thng tin theo quy nh c ghi chp y , chnh xc.


Ni khoa

B.6 - BNG KIM KHM LM SNG TUYN GIP


1. - Dng c: ly nc ung, thc o, ng nghe, my o huyt p, ng h bm giy, ba phn x;

- Ni khm sch s, nh sng;- NVYT mang trang phc theo

quy nh, ra tay thng quy.

Gip thc hin thm khm c thun li.

- Dng c khm v sn sng s dng;


THC HIN2. NVYT

- Cho hi NB/ngi nh, t gii thiu tn v nhim v ti CSYT;

- Gii thch vi NB v quy trnh khm bnh, hng dn NB t th ph hp cho vic khm bnh.

- To tm l tt cho NB;

- To t th thun li nht cho vic khm bnh.


- NVYT th hin thi sn sng h tr NB;

- NB c t ng t th khm bnh.

3. Hi bnh- Hi l do NB n CSYT;- Hi bnh s (ch n triu

chng c nng nh nh trng ngc, run tay, khn ting, tng/gim cn nhanh, chn n, to bn; thuc iu tr trc khi n khm?);

- Hi tin s bnh lin quan ca NB v gia nh? Ch n ch n ung c b sung I-t khng?


- Khai thc c ng v y bnh s v tin s;

- Thi tn trng ng mc cc phong tc tp qun v thi quen trong CSSK ca NB, s dng cu hi m, ng ph hp.

4. Khm ton thn- Tri gic;- Th trng, da, nim mc, tc

(kh gin d gy)?- Mt li/lit vn nhn? - C ph khng?- Cc du hiu sinh tn: mch,

nhit , huyt p, nhp th?- Xc nh NB c kh th khng?


Pht hin c cc triu chng ton thn lin quan n cc bnh l tuyn gip.


TT CC BC NGHA YU CU CN TKhm tuyn gip

5. Nhn- NB ngi v NVYT ngi i

din: Quan st mu da c; Nhn hnh th c, cc khi/u/

cc vng quanh tuyn gip.- Nhn trc din NB, nhn

nghing t pha bn NB;- ngh NB nut (ung nc) quan st.

nh gi s b cc bu/u/cc vng c.

- Quan st hai t th: thng v nghing; quan st khi NB bnh thng v khi nut;

- M t c nhng g quan st thy.

6. S- S tuyn gip: NB hi nghing ra trc v hi

nng cm chng c c v m rng vng gip trng cho d s;

Yu cu NB nut khi s; S ln lt tng thy ca tuyn

gip; Khm eo tuyn gip.- S kh qun trn hm c (c b y lch khng?);

- S hch vng c;- S lng bn tay.

Gip xc nh kch thc, tnh cht ca bu gip, ca hch; Xc nh s xm ln/chn p ca bu gip.

- Khm ng k thut, nh gi ng c im tuyn gip qua khm;

- Xc nh lng bn tay nng m/lnh kh?

7. Khm run tay Xc nh s b NB c cng gip khng?

Thc hin ng k thut: NB a hai tay thng v pha trc mt, nhm mt, NVYT quan st run u ngn tay (t t giy ln tay NB d quan st).

8. Thc hin nghim php Pemberton.

Gip xc nh bu gip chm sau xng c.

Thc hin ng k thut khm nghim php Pemberton (NB ng gi cao hai tay v ht su; Nghim php dng tnh khi thy NB mt bng v tnh mch c phng).

9. o tuyn gip Dng thc dy o vng qua ch to nht ca tuyn.

theo di s tin trin ca tuyn gip.

Xc nh c chu vi tuyn gip qua ch to nht ca tuyn.


Ni khoa

TT CC BC NGHA YU CU CN T10. G phn x gn xng. Xc nh tng phn

x gn xng trong cng gip.

Xc nh ng nu c tng phn x gn xng.

11. Nghe- Nghe ti tuyn gip;- Nghe tim.

- nh hng pht hin bu gip mch;

- Xc nh ri lon nhp tim trn NB b cng gip.

- M t ng kt qu nghe;- Pht hin c chnh xc

cc bt thng khi nghe tim.

12. Kt thc khm- Gip NB tr v t th thoi mi;- Gii thch kt qu khm cho NB

v hng x tr tip theo;- Ra ch nh xt nghim hoc

thm d khc (nu cn);- T vn v tr li cc cu hi ca

NB (nu c);- Cho v cm n NB;- Thu dn dng c, ra tay;- Ghi kt qu khm vo h s

bnh n.

- m bo quyn c thng tin cho NB;

- Hon chnh vic khm;

- m bo ghi chp cc thng tin theo quy nh hnh chnh v chuyn mn.

- NB hiu r v tnh trng bnh v yn tm hp tc vi NVYT trong chn on, iu tr v chm sc;

- a ra hng x tr tip theo v cc ch nh xt nghim hp l;

- Ghi bnh n r rng v y .


B.7 - BNG KIM KHM NGI BNH HN M


1. - Dng c: ng nghe, my o huyt p, nhit k, ng h bm giy, ba phn x, n chiu ng t;






- Mang trang phc theo quy nh ca CSYT v ra tay ng quy trnh.

THC HIN2. NVYT

- Cho hi ngi nh, t gii thiu tn v nhim v ti CSYT;

- Gii thch vi ngi nh v quy trnh khm v hng dn ngi nh nhng iu cn thit h hp tc.

To tm l yn tm cho ngi nh v thun li cho vic khm bnh.

- Ngi nh yn tm v bit cch hp tc vi NVYT trong qu trnh khm;

- NVYT giao tip ph hp vi vn ha, th hin thi khn trng, sn sng h tr NB.

3. Hi bnh (ngi nh)- Hi l do NB hn m;- Bnh s: ch n thi im,

hon cnh xut hin, din bin ca hn m trn NB; c iu tr g trc khi n CSYT?

- Tin s bnh lin quan ca bn thn NB v gia nh?


- Khai thc bnh s, tin s bnh lin quan gip nh hng nguyn nhn v hng x tr tip theo.

4. Khm du hiu sinh tn v ton thn Khm du hiu sinh tn:- Mch, nhit , huyt p;- Tn s th, kiu th, mi hi th. Khm ton thn:- Th trng;- Da, nim mc (mu sc, c xy

xc trn da, vt thm tm);- C chy mu cc hc t nhin?

nh hng nguyn nhn v mc hn m.

- nh gi chnh xc cc du hiu sinh tn;

- nh gi nhanh c tnh trng ca NB.


Ni khoa

TT CC BC NGHA YU CU CN T5. Khm nh gi nhng ri lon

thn kinh thc vt- Ri lon h hp: nhp th, kiu

th hay ngng th?- Ri lon tun hon?- Ri lon bi tit: m hi;- Ri lon cc c trn; - Phn x nut v phn x ng

t vi nh sng.

nh gi mc nng ca ri lon thn kinh thc vt.

Khm, nhn xt ng cc ri lon thn kinh thc vt.

6. Khm thcp ng vi cc kch thch (li ni, au).

nh gi mc ri lon thc.

Xc nh c ri lon thc mc t gim n mt hon ton.

7. Khm lit mt- Quan st nhn trung, rnh mi

m, np nhn trn, du hiu Charles Bell;

- Nghim php Pierre Marie - Foix.

nh gi lit mt. - Quan st c du hiu tn thng;

- Thc hin c cc nghim php bn ng k thut v nhn nh chnh xc kt qu.

8. Khm cc dy thn kinh vn nhn- ng t, phn ng ca ng t

vi nh sng mt hay hai bn;- Vn ng nhn cu: lm trc

nghim mt - u, trc nghim mt - tin nh.

nh gi tn thng dy thn kinh vn nhn, tn thng thn no.

Thc hin khm ng k thut v nhn nh kt qu chnh xc.

9. Khm vn ng- Quan st t th nm ca NB,

t th bn chn (c ra mt ging?);

- Lm nghim php Raimist (nhc tay ln cao v th ri t do);

- Khm phn x: gn xng, da bng, Babinski, Hoffman.

nh gi lit vn ng chi.

Khm, nhn xt ng.

10. Khm du hiu mng no- au u, nn ma;- Gy cng, Kernig (+), Brudzinski

(+).

nh gi du hiu mng no.

Khm v nhn xt ng.


TT CC BC NGHA YU CU CN T11. nh gi mc hn m theo

thang im GlasgowBnh thng E + V + M = 15 im.GCS 8: tin lng xu;GCS 9 12: tin lng kh;GCS 13: tin lng tt.

Gip tin lng, theo di, iu tr.

nh gi ng mc hn m.

CCH TNH IM GLASGOW

KHM BIU HIN P NG IMp ng bng mt (E) M mt t nhin

M mt khi giM mt khi kch thch auKhng m mt d c kch thch au

4321

p ng bng li ni (V) Tr li ng tn h, a ch (nh hng tt)Tr li ln ln (nhm ln, khng nh hng tt)Tr li hiu c nhng khng thch hpTr li khng th hiu c ( khng r)Im lng

54321

p ng bng vn ng (M)

Thi hnh ng cc mnh lnh vn ngC ng cho thy chnh xc v tr kch thch auCo chn hoc tay mt cch yu tCo cng mt v no khi kch thch auDui cng mt no khi kch thch auKhng p ng vi kch thch au

654321

TNG S IM: 15


Ni khoa

B.8 - BNG KIM KHM VN NG


A. Khm vn ng t ch1. Quan st kh nng vn ng

- T th tay, chn khi NB i li (chn i vt c...?);

- T th tay, chn khi NB nm.

Xc nh kh nng vn ng t ch ca NB.

- Khm t m, ln lt t trn xung, i xng, so snh hai bn;

- Hng dn NB r rng;- Nhn xt ng kh nng

vn ng t ch ca NB.2. Tm c lc (nghim php chng i)

- Hng dn NB lm mt s ng tc thng thng cc chi;

- Trong khi NB lm nhng ng tc thng thng k trn, NVYT ln lt chng li cc ng tc .

Kim tra c lc ca tng nhm c.

Khm t m, ln lt t trn xung, i xng, so snh hai bn.

3. Nghim php Barr- Chi trn: NB nm nga, mt

nhm gi thng hai tay to mt gc 60o vi mt ging, bn no lit s ri xung trc;

- Chi di: NB nm sp. Cng chn NB t th 45o vi mt ging, bn no lit s ri xung trc.

nh gi c lc ca chi (gc chi).

- NB nhm mt khi khm;- Khm ng k thut;- Hng dn NB r rng;- Nhn xt ng kt qu

(+)/(-).

4. Nghim php MingazziniNB nm nga, hai chn gi ln, cng chn thng gc vi i, i vung gc vi mt ging, 2 bn chn khng chm nhau. Bn no lit s ri xung trc.

nh gi c lc ca chi di (gc chi).

- NB nhm mt khi khm;- Khm ng k thut;- Hng dn NB r rng;- Nhn xt ng kt qu

(+)/(-).5. Nghim php gng km

NB bm cht ngn tay ci vo ngn tr to thnh mt gng km, NVYT lun ngn tay ci v ngn tay tr ca mnh v ly sc dng ra, bn no lit th gng km bn s ri ra d dng.

nh gi c lc ngn chi trn.

- Khm i xng, so snh hai bn;

- Khm ng k thut;- Hng dn NB r rng;- Nhn xt ng kt qu

(+)/(-).



B. Khm trng lc c6. Khm chc ca c

Dng tay s nn cc c ca chi hai bn, so snh chc ca c hai bn.

nh gi trng lc c, xc nh lit cng/mm.

- Khm t m, khm ln lt t trn xung, i xng v so snh hai bn;


bnh thng/tng/gim.7. Khm co doi c: lm cc

ng tc gp, dui c ri so snh hp ca cc gc khp vi pha bn i din. - Chi trn: NB vng tay qua c

v t lng bn tay vo vng xng b vai cng bn;

- Chi di: NB a gt chn t vo mng cng bn.

nh gi trng lc c (ch yu gc chi) xc nh lit cng/mm.



bnh thng/tng/gim.

8. Tm ve vyNVYT cm c chn, c tay NB lc mnh hoc NVYT lc c thn NB quay phi quay tri xem bin vung ca c hai bn tay/chn NB.

nh gi trng lc c, ch yu ca ngn chi, xc nh lit cng/mm.



bnh thng/tng/gim.C. Khm phi hp ng tc v thng bng

9. - Nghim php ngn tay ch mi: NB nhm mt, dang hai tay, sau ln lt ch vo mi ca mnh.- Nghim php gt chn u gi:NB nm nga, chn dui thng. Yu cu NB gi mt chn ln cao v t gt ln u gi chn bn kia, sau lt gt dc theo mo xng chy xung ti c chn.- Nghim php lt p bn tay lin tip: Yu cu NB lt p lin tip hai bn tay.

nh gi kh nng phi hp ng tc.

- NB nhm mt khi khm;- Khm ng k thut;- Hng dn NB r rng;- Nhn xt c kh nng

phi hp ng tc.


Ni khoa


10. Du hiu RombergNB ng chm chn (hai ngn ci chm nhau), nhm mt v gi hai tay ra pha trc.

nh gi kh nng thng bng.

- NB nhm mt khi khm;- Khm ng k thut;- Hng dn NB r rng;- Nhn xt c kh nng

thng bng.D. ng tc t ng

11. Run, ma git, ma vn Pht hin mt s ng tc t ng bt thng.

- NB nhm mt khi khm;- Khm ng k thut;- Hng dn NB r rng;- Quan st v nh gi cc ng tc.

E. Kt thc thm khm12. - Thng bo kt qu thm khm

v hng x tr tip theo cho NB/ngi nh, tr li cc bn khon thc mc lin quan ca NB/ngi nh (nu c);

- Thu dn dng c, ra tay, ghi chp h s bnh n.

m bo quyn c thng tin cho NB.

- NB an tm, sn sng hp tc tip vi NVYT;




B.9 - BNG KIM KHM THC TH C XNG KHP


1. - Dng c: 1 thc dy, 1 thc o gc, 1 ba phn x, 1 bt v trn da, kim v tm bng khm cm gic;

- Ni khm sch s, rng ri, nh sng; 1 ging khm (khng c thnh ging 4 pha), 1 gh u (khng c ta);

- NVYT mang trang phc theo quy nh, ra tay thng quy.





THC HIN2. NVYT

- Cho NB/ngi nh, t gii thiu tn v nhim v ti CSYT;

- Hi l do NB n CSYT;- Gii thch vi NB v quy trnh

khm v hng dn NB/ngi nh nhng iu cn thit h hp tc.

- To tm l tt cho NB;

- To t th thun li nht cho vic khm bnh.


- NVYT th hin thi sn sng h tr NB;

- NB c ng t th khm bnh (t th thay i ph hp vi cc ng tc khm c th).

3. Nhn t th chung ca NB khi i li, vn ng.

Gi chn on. Xc nh ng cc t th bt thng: i kiu thng gi/ kiu vt tp

4. Khm cQuan st v s nn thn c: NB ngi, NVYT quan st, sau s nn nh gi chc ca c, mt c:- Cc vng c ni r mt, c;- Cc vng c chi trn: c delta,

c nh u, c cng tay;- C ngc ln, c cnh ct sng,

c mng;- Cc vng c ni r chi di:

c t u i, c dp.

nh gi c im ca c qua nhn v s nn.

- Nhn nh c cc vng c quan st: pht trin bnh thng, cn i, i xng hay c bt thng nh: sng n, (vim c), teo c (tng vng, i xng)...

- nh gi c: c bnh thng, co cng hay teo nho.


Ni khoa

TT CC BC NGHA YU CU CN To chu vi c: - nh du im mc t thc

dy;- Dng thc dy vng ngang

quanh vng tay hoc chn c thn c ni r nht ( nh du) o chu vi c. Thng o ti mt s c:

C chi trn: c delta, c nh u, c cng tay;

C chi di: c t u i, c dp.

G phn x c:Dng ba phn x g 1-2 nht vo vng bp c ni r nht ca thn c cn khm. Thng l cc c sau: C chi trn: c delta, c nh u; C chi di: c t u i.

nh gi teo c.

nh gi phn x c.

- o ng ngang mc nhau c hai bn chi v so snh;

- Nhn nh c: c to u bnh thng, i xng, hay c biu hin teo c, ph i c...

So snh hai bn v nhn nh c: bnh thng hay rung git, mt phn x co c, xut hin nt co c.

5. Khm xngQuan st v s nn: NB ng thng, NVYT quan st, sau s nn nh gi cc vng xng, thng cc vng sau: u, mt; Trc chi trn: cnh-cng tay,

bn tay; Trc chi di.o chiu di ca chi di:- o chiu di tuyt i: NB

nm nga, dng thc dy o t mu chuyn ln n li cu ngoi (hoc khe khp gi ngoi);

- o chiu di tng i: NB nm nga, dng thc dy o t gai chu trc trn xung n mt c trong mi bn. Hoc o t gai chu trc trn xung n li cu ngoi mi bn v so snh.

nh gi c im ca xng qua nhn v s nn.

Xc nh di ca chi di.

- Khm t trn xung, khm i xng hai bn;

- Nhn nh c: bnh thng hay c bin dng, d dng thuc v xng, u xng. Trc chi bt thng.

- o chnh xc chiu di ca chi v so snh hai bn;

- Nhn nh c: bnh thng, ngn chi.

6. Khm khpKhm khp vai:- Tm cc im au: n tm cc im au mt trc khp, rnh c nh

Xc nh im au v ng tc khp vai.

- Khm t m hai bn v so snh;


TT CC BC NGHA YU CU CN T- u, mm khp vai, khp c n, phn trn xng b;

- Thc hin ng tc khp vai: cho NB t lm mt s ng tc ging nh chi u, gi lng, gi tay, nhn vai ln, h vai xung. Gi tay ra trc, khp vo, dng ra, quay vng trn, dang rng cnh tay sang hai bn, a tay ra sau v bn tay mm xng b vai bn i din. Quan st v nhn nh.

- Hng dn NB r rng;- Nhn nh c: khp

bnh thng, khp bin dng, vn ng khp hn ch theo t th no?

7. Khm khp hng- Thc hin ng tc ch ng;- Cho NB t lm mt s ng

tc nh ng thng, ng mt chn, ci ngi ra trc, dng hai chn, ngi xm, nm nga. Quan st NB v nhn nh;

- Thc hin ng tc th ng: Hn ch vn ng: NB thy kh ng lu, ngi xm b hn ch, bc ln bc cao au.

i khp khnh: thng tng dn.

- Khm cc ng tc: thc hin tng bn:

NB nm nga: thc hin cc ng tc dng, khp, gp khp hng t th khp gi dui v gp khp hng t th khp gi gp, xoay trong v xoay ngoi t th hng gp;

NB nm sp: khm cc ng tc xoay trong, xoay ngoi t th hng dui.

Xc nh vn ng ca khp hng.


- Hng dn NB r rng;- Nhn nh c: khp

bnh thng, vn ng khp hn ch theo t th no?

8. Khm khp gi- Thc hin ng tc ch ng: ngh NB t thc hin cc ng tc gp, dui;

- Thc hin du hiu bo khp, di ng xng bnh ch;

nh gi vn ng khp gi v tn thng dy chng khp gi.


- Hng dn NB r rng;


Ni khoa

TT CC BC NGHA YU CU CN T- Thc hin du hiu bp bnh

xng bnh ch v du hiu ba ng (khi khp gi c dch);

- Khm dy chng bn, dy chng cho.

- Nhn nh c: khp bnh thng, vn ng khp hn ch theo t th no? C tn thng dy chng?

9. Khm khp cng chu- S nn: n vo vng khe khp

cng chu;- Thc hin nghim php banh

khung chu;- Thc hin nghim php p

khung chu.

Tm du hiu au khp cng chu.

- Khm hai bn v so snh;- Hng dn NB r rng;- Nhn nh c: NB c au ti khp cng chu.

10. Khm ct sng- Chun b NB: bc l ton b ct

sng t chm xung ti xng cng ct, t th NB ng chm hai gt chn, hai tay thng v p vo hai i;

- Nhn: NB t th ng. Quan st pha lng v nghing thy c ng cong sinh l ca ct sng: on sng c hi cong li ra sau, on lng cong li ra sau v tht lng li ra trc;

- S NB t th ng: s mit dc

theo ct sng pht hin du hiu li gai hay tt gai. S nn c cnh ct sng nh gi trng lc c;

NB t th nm sp: n vo gai, vng lin gai, rnh lin t sng v cc im cnh ct sng pht hin im au.

- Khm vn ng ct sng c Cho NB t thc hin cc ng tc: ci, nga, nghing, quay sang hai bn;

Gip thm khm c thun li;

Quan st hnh dng ct sng;

Pht hin trng lc c cnh ct v im au ti ct sng;

nh gi vn ng ct sng c;

- Hng dn NB r rng;- Bc l y vng ct

sng;

- Hng dn NB r rng;- Nhn nh c: bnh

thng hay c nhng thay i v ng cong ca ct sng: g, vo, n; khm ng k thut;

- Nhn nh c: ct sng bnh thng hoc c tng trng lc c (co cng c cnh ct sng), gim trng lc lm thay i ng cong sinh l ca ct sng. C im au ti ct sng hay cnh ct sng?

- Khm ng k thut;- nh gi c: ct sng

c bnh thng hay hn ch tm vn ng ca ng tc ci, nga...


TT CC BC NGHA YU CU CN T- Khm vn ng ct sng ngc o gin lng ngc: t thc dy vng qua lng ngc NB (ngang mc khoang lin sn 4), o chu vi lng ngc khi NB ht vo ht sc v th ra ht sc ( gin lng ngc bnh thng 3-4cm, hn ch khi


Ni khoa

B.10 - BNG KIM KHM 12 I DY THN KINH S NO


1. - Dng c L hp cht c mi (du inh

hng, bc h, long no, nc hoa, thuc l);

Bng o th lc, ba che mt; Mt cht ng/mui sch; Tm bng sch; li, que mm qut hng; ng h bn (c ting ku

tch tc); H s bnh n, giy bt.- Ni khm sch s, nh sng;- NVYT mang trang phc theo


- Gip thc hin thm khm thun li;




THC HIN2. NVYT


- Hi l do n khm;- Gii thch vi NB/ngi nh

v quy trnh khm v hng dn nhng iu cn thit h hp tc.

To tm l yn tm cho NB/ngi nh v thun li cho vic khm bnh.

- NB/ngi nh yn tm v bit cch hp tc vi NVYT trong qu trnh khm;

- NVYT giao tip ph hp vi vn ha, th hin thi sn sng h tr NB.

3. Khm dy I (thn kinh khu gic)- Hng dn NB ly ngn tay tr

bt mt bn mi li;- NVYT a l cha hp cht c

mi ti gn mi (bn khng b bt). NVYT ghi nhn kt qu phn bit mi ca NB;

- Thc hin tng t vi mi bn kia ca NB v so snh hai bn.

Nhn nh xem c tn thng dy thn kinh I khng.

- Khm ng k thut;- Nhn nh c tnh trng

khu gic ca NB bnh thng hay bnh l.

4. Khm dy II (thn kinh th gic)Khm th lc: - NB che mt bn mt;- Dng mt bng (bng th lc) in

cc mu ch c kch thc khc nhau. bng cch xa 5m, ch

Nhn nh xem c tn thng dy thn kinh II khng.

- Khm nh nhng, t m, ng k thut;

- nh gi ng tnh trng th lc v th trng ca NB (tt hay gim).


TT CC BC NGHA YU CU CN T- tng loi ch cho NB c v nh gi th lc ca NB;

Khm th trng: - NVYT ngi i din cch NB

1m. - Kim tra mt phi ca NB: bo

NB che mt tri bng mt tm ba v gi yn v tr ca u. NVYT che mt phi v hng dn NB nhn thng vo mt tri mnh, mt tri ca NVYT cng phi nhn thng vo mt phi ca NB. Sau NVYT gi mt ngn tay tri ln ngang mt v x dch dn v pha bn tri cho n khi NB khng nhn thy na (lun hi NB trong lc x dch ngn tay xem c cn nhn thy ngn tay na hay khng) v so snh ngay vi th trng ca chnh NVYT nh gi xem NB c b thu hp khng?

- Lm tng t nh vy vi mt tri ca NB.

5. Khm dy III, IV, VI (thn kinh vn nhn)Yu cu NB nhn c nh vo mt vt (ngn tay NVYT, u bt). Sau di chuyn vt chm theo chiu ngang: phi-tri, tri-phi; chiu dc: trn-di, di-trn v theo chiu chch: di-trn, trn-di. NB ch a mt nhn theo vt v khng quay u. Sau vt ng gia cch xa hai mt, a dn vt vo st mt cch 6cm, hai nhn cu s quy t vo pha mi v ng t co li (phn x iu tit). Nu a vt xa, dn hai mt li tr v v tr c v ng t gin ra.

Nhn nh xem c tn thng dy thn kinh vn nhn khng.

- NB hp tc tt;- Khm nh nhng, t m, ng k thut;

- nh gi ng tnh trng vn nhn ca NB: bnh thng hay bt thng?

6. Khm dy V (dy tam thoa)- Khm vn ng: hng dn NB

cn cht rng, ri s c nhai v c thi dng, bnh thng cc c hai bn u rn nh nhau, nu c

Nhn nh xem c tn thng dy thn kinh V khng.



Ni khoa

TT CC BC NGHA YU CU CN T- bn no lit th s nho hn c

bn kia, khi h mm cm lch sang bn lit.

- Khm cm gic: Khm v gic 2/3 trc li:

hng dn NB th li ri t ng, t mui vo phn 2/3 trc li, yu cu NB ghi cm gic nhn c ra giy;

Khm phn x gic mc: dng mt tm bng sch, mt ngn tay vnh mi trn ca NB v kho lo qut nh u tm bng trn gic mc (nhng khng NB nhn thy) NB cm thy xt mt v nhm mt li.

- nh gi ng tnh trng dy thn kinh V bnh thng hay bt thng.

7. Khm dy VII (dy thn kinh mt)Khm vn ng: - Hi NB khi sc ming nc

chy ra bn no?- Hng dn NB nhe rng, ci

ni, xc nh cc du hiu bt thng nh: mt NB mo v bn lnh, np nhn mi m bn lit m hn bn lnh;

- Tm du hiu Charles Bell: NB nhm mt khng kn, bn lit nhn cu a ln trn h lng trng di (du hiu c bit ca lit VII ngoi bin);

- Khi NB h to mm, NVYT dng bn tay di cm v cm gi li, c bm da c bn lit khng ni cng ln l du hiu chng t lit nh dy VII;

- NB hn m: lm nghim php Pierre Marie - Foix: n hai ngn tay vo gc hm chm, NB au nhn mt, thy mt mo v bn lnh;

- Quan st NB th thy m bn lit php phng nh lc thi la.

Nhn nh xem c tn thng dy thn kinh VII khng.


- nh gi ng tnh trng dy thn kinh VII bnh thng hay bt thng.


TT CC BC NGHA YU CU CN T8. Khm dy VIII (dy thn kinh

thnh gic)- Dng ng h pha sau NB, a dn li gn tai cho n khi NB bt u nghe thy ting tch tc ri so snh khong cch nghe c y vi khong cch ca ngi bnh thng cng mt ng h;

- Ni to, ri ni thm (khng NB nhn mm ngi ni) xem NB tr li c ng khng.

Nhn nh xem c tn thng dy thn kinh VIII khng.

- Khm ng k thut;- nh gi ng tnh trng

thnh gic ca NB bnh thng hay bt thng.

9. Khm dy IX (dy thn kinh li hu)- Kim tra v gic 1/3 sau ca li;- Th phn x nn: dng mt que

mm qut nh vo cc ct hnh nhn hoc thnh sau hu hng, NB s bun nn, nu lit NB s mt phn x nn.

Nhn nh xem c tn thng dy thn kinh IX khng.

- Khm nh nhng, ng k thut;

- nh gi ng tnh trng dy thn kinh IX bnh thng hay bt thng.

10. Khm dy X (dy thn kinh ph v)- Hi NB c nghn khi n, sc

khi ung nc?- Nghe ging ni NB c khn

ting, mt ting?- Quan st vm hng bng cch li v yu cu NB ku a, a. Bnh thng mn hu c nng ln cn i hai bn. Nu lit mt bn, mn hu bn khng nng ln c (c du hiu ko mn hu). Nu lit hai bn, vm hu khng c ng.

Nhn nh xem c tn thng dy thn kinh X khng.


- nh gi ng tnh trng dy thn kinh X bnh thng hay bt thng.

11. Khm dy XI (dy thn kinh gai) - Khm c c n chm: Yu cu NB quay u: khi lit

NB s quay u kh khn; Khi NVYT ly tay chng li ng tc quay u ca NB, nu NB lit dy XI s khng thy ni r thng c c n chm.

Nhn nh xem c tn thng dy thn kinh XI khng.


- nh gi ng tnh trng c c n chm v c thang bnh thng hay bt thng.


Ni khoa

TT CC BC NGHA YU CU CN T- Khm c thang: ngh NB

nng cao hai vai, trong lc NVYT dng hai tay n hai vai xung, so snh hai bn, bn no yu l c lit (nhn pha sau, vai bn lit sa xung thp).

12. Khm dy XII (dy thn kinh h nhit)- ngh NB th li cng di

cng tt (khi lit dy XII, li s y sang bn lit);

- ngh NB nut v hi quan st NB ni (lit dy XII mt bn s gy kh nut, kh ni).

Nhn nh xem c tn thng dy thn kinh XII khng.


- nh gi ng tnh trng dy thn kinh XII bnh thng hay bt thng.

13. Kt thc khm- Gip NB tr v t th thoi mi;- Thng bo cho NB/ngi nh

v kt qu khm v hng x tr tip theo;

- Tr li nhng bn khon, thc mc ca NB/ngi nh (nu c);

- Cho v cm n NB/ngi nh;- Thu dn dng c, ra tay;- Ghi kt qu khm v xut x

tr tip theo vo h s bnh n.

- m bo quyn c thng tin ca NB;

- xut c hng x tr tip theo;

- m bo quy nh ghi h s bnh n.

- NB/ngi nh hiu c tnh trng bnh hin ti ca NB, yn tm hp tc vi NVYT trong qu trnh chn on v iu tr bnh;

- a ra cc xut x tr tip theo mt cch hp l;

- Thu dn dng c gn gng;- Ghi h s bnh n r rng

v y theo quy nh.


B.11 - BNG KIM KHM CM GIC


1. - Dng c: kim t u, tm bng, ng nghim nc nng v lnh, m thoa, mt s vt quen thuc vi NB;







THC HIN2. NVYT


- Hi l do NB n khm;- Gii thch vi NB/ngi nh

v quy trnh khm v hng dn nhng iu cn thit h hp tc.



- NVYT giao tip ph hp vi vn ha vng min, th hin thi sn sng h tr NB.

3. Khm cm gic s Yu cu NB nhm mt khi khm. Dng tm bng qut vo tng vng da NB, yu cu NB tr li kt qu.

Xc nh cm gic s ca NB cn hay mt?

- Khm ng k thut, t m, i xng hai bn;

- Nhn nh ng tnh trng cm gic ca NB (cm gic s cn hay mt?).

4. Khm cm gic au Yu cu NB nhm mt khi khm. Dng kim u t, chm nh vo da v yu cu NB tr li c cm gic au hay khng.

Xc nh cm gic au ca NB c hay khng?

- Khm ng k thut, nh nhng, t m, i xng hai bn;

- Nhn nh ng kt qu khm (cm gic au ca NB l bnh thng, tng hay gim?).

5. Khm cm gic nng, lnh Yu cu NB nhm mt khi khm. Dng hai ng nghim, mt ng ng nc nng, mt ng ng nc , p vo da NB. Tin hnh lm tng vng v hi cm gic ca NB.

Xc nh cm gic nng lnh ca NB cn hay mt?


- Nhn nh ng kt qu (cm gic nng lnh ca NB cn hay mt?).


Ni khoa

TT CC BC NGHA YU CU CN T6. Khm cm gic rung

Yu cu NB nhm mt khi khm. Dng m thoa g mnh cho rung ri vo cc xng st da nh xng bnh ch, xng chy, gai xng chu, xng khuu Hi NB cm gic ca cc vng xng .

Xc nh cm gic rung ca NB cn hay mt?


- Nhn nh ng kt qu (cm gic rung NB cn hay mt?).

7. Khm cm gic t th, v tr Yu cu NB nhm mt, NVYT mt ngn tay hoc ngn chn no ca NB mt t th v v tr nht nh ri ngh NB ni cho bit t th v tr ca ngn ny hoc yu cu NB ngn tay hay ngn chn bn i din t th, v tr tng t.

Xc nh cm gic t th, v tr ca NB cn hay mt?


- Nhn nh ng kt qu khm (cm gic t th, v tr NB cn hay mt).

8. Khm cm gic nhn bit vt NB nhm mt, a nhng dng hng ngy quen thuc v yu cu NB s v cho bit l vt g.

Xc nh cm gic nhn bit vt ca NB cn hay mt?


- Nhn nh ng kt qu khm (cm gic nhn bit NB vt cn hay mt).












- Ghi h s bnh n r rng v y theo quy nh.


B.12 - BNG KIM KHM HI CHNG MNG NO


1. - Dng c: kim u t, ba phn x, n pin nh, ng nghe, huyt p k, nhit k, ng h bm giy;







THC HIN2. NVYT


- Hi l do NB n khm, tin s v bnh s lin quan;

- Gii thch vi NB/ngi nh v quy trnh khm v hng dn nhng iu cn thit.



- Khai thc tin s v bnh s theo bng kim;

- NVYT giao tip ph hp vi vn ha, th hin thi sn sng h tr NB.

3. Khm ton thn- Quan st trng thi thn kinh

ca NB: tnh/li b?- nh gi ton trng, da, nim mc?- o cc du hiu sinh tn: mch,

nhit , huyt p, nhp th.

Xc nh tnh trng chung v nh hng cho cc x tr tip theo.

- M t ng, y v chnh xc cc thng s v triu chng ton thn;

- Xc nh nhanh cc tnh trng NB cn cp cu ngay.

4. Hi tam chng mng no- au u: tng ln khi c ting ng mnh?

- Nn: nn vt, nn d dng?- To bn: ko di, khng chng

bng?

pht hin cc triu chng c nng ca tam chng mng no.

Hi y tam chng mng no.

5. Nhn- Quan st t th nm ca NB: t

th hnh c sng;- Quan st cc ban xut huyt

ngoi da v hoi t.

Pht hin cc triu chng gip nh hng chn on NB.

- Quan st k NB;- Xc nh ng t th c

bit gi n hi chng mng no NB;

- Xc nh c cc ban xut huyt do no m cu (kch thc khng ng u, c th km hoi t).


Ni khoa

TT CC BC NGHA YU CU CN T6. S

Xc nh tnh trng ca thp ( tr cn thp)

Xc nh biu hin tng p lc ni s tr (thp phng).

Xc nh ng tnh trng thp ca tr: phng/bnh thng/thp trng?

7. Khm du hiu cng gy NB nm nga, u khng gi. Mt tay nh pha trc ngc NB, mt tay pha sau gy v nng nh u NB ln, ghi nhn bt thng nu thy NB c gy dui cng, cm khng gp vo ngc c, ng thi c ngc NB cng nhc ln theo.

Pht hin c s co cng c vng sau gy khng?

- Hng dn NB r rng v khm ng k thut. Cn phi lm nhiu ln trnh nhn nh nhm ln do NB cng li;

- nh gi ng du hiu cng gy dng hoc m tnh.

8. Khm du hiu Kernig- NB nm nga, chn dui thng.

Mt tay ca NVYT t mt trn khp gi, gi cho NB khng co khp gi, tay kia t t nng hai chn NB theo hng thng gc vi mt ging;

- Kernig dng tnh nu: NB ku au hay/v co khp gi khi mi nng cng chn ln gc 450 so vi mt ging.

Pht hin du hiu Kernig dng tnh NB vim mng no.

- Hng dn NB r rng v khm ng k thut, nh nhng;

- nh gi ng du hiu Kernig dng tnh hoc m tnh.

9. Du hiu Brudzinski- NB nm nga, chn dui thng.

Tay tri NVYT t ln ngc NB, tay phi sau u NB v nng dn u NB ln so vi mt ging, trong khi tay tri gi khng ngc NB di chuyn;

- Du hiu Brudzinski dng tnh khi c hin tng co cng, cng chn NB gp vo i, i gp vo bng, NB co chn li.

Pht hin du hiu Brudzinski dng tnh NB vim mng no.

- Hng dn NB r rng;- Khm t m, y ;- Khm ng k thut;- nh gi ng du hiu

Brudzinski dng tnh hoc m tnh.

10. Khm cm gic au, phn x gn xng (theo bng kim khm phn x)- Bp nh c, gi vo da hay chm

nh kim vo da (NB s ku au v phn ng li rt mnh);

- G cc phn x gn xng (NB thng p ng tng hn bnh thng).

Pht hin c hin tng tng cm gic hoc tng phn x gn xng NB.

- Khm t m, nh nhng, ng k thut;

- nh gi chnh xc nhng thay i bnh l NB.


TT CC BC NGHA YU CU CN T11. Khm phn x vi nh sng

Chiu nh sng n pin nh vo mt NB: NB s nh sng hoc thy tng cm gic au khi nhn vo ngun nh sng chiu (NB thch quay mt vo ch ti).

Pht hin c hin tng tng cm gic hoc tng phn x vi nh sng NB.

- Hi v quan st k NB trong khi khm;

- nh gi ng thay i bnh l.

12. Du hiu vch mng noLy mng tay hoc mt kim u t vch nh nhiu ng trn da bng NB, nh gi du hiu vch mng no dng tnh khi s xut hin cc vt vch thm hn v tn ti lu hn so vi ngi bnh thng.

Xc nh du hiu vch mng no m tnh hay dng tnh NB.

- Khm ng k thut;- nh gi ng du hiu

vch mng no m tnh hay dng tnh.

13. Kt thc khm- Thng bo cho NB/ngi nh








- NB/ngi nh hiu c tnh trng bnh hin ti ca NB, hp tc vi NVYT trong qu trnh iu tr bnh;

- a ra cc xut x tr tip theo;

- Ghi h s bnh n r rng v y theo quy nh.


Ni khoa

B.13 - BNG KIM KHM PHN X


1. - Dng c: ba phn x, kim u t, ng nghe, huyt p k, nhit k, ng h bm giy;







THC HIN2. NVYT


- Hi l do NB n khm, tin s v bnh s lin quan;

- Gii thch vi NB/ngi nh v quy trnh khm v hng dn nhng iu cn thit;

- Cm ba g phn x bng ngn ci v ngn tr.

NB: t th ph hp, th lng c, khng ln gn trong qu trnh khm phn x v phi hp theo yu cu ca NVYT.



- Khai thc tin s v bnh s theo bng kim;

- NVYT giao tip ph hp vi vn ha vng min, th hin thi sn sng h tr NB.

3. Khm ton thn- Quan st trng thi thn kinh ca

NB: tnh/li b- nh gi ton trng, da, nim mc?- o cc du hiu sinh tn: mch,

nhit , huyt p, nhp th.

Xc nh tnh trng chung v nh hng cho cc x tr tip theo.

- M t ng, y v chnh xc cc thng s v triu chng ton thn;

- Xc nh nhanh cc tnh trng NB cn cp cu ngay.

A. Khm phn x gn xng4. Khm phn x trm quay

- T th: NB nm, cng tay gp, hai bn tay ln bng hoc tay NB bung xui, NVYT cm tay NB gp li khong 45o so vi mt ging.

- V tr g: mm trm quay;- Phn x xut hin: gp v quay

nga cng tay.

Xc nh xem phn x trm quay bnh thng, tng hay gim?

- NB hp tc tt;- Khm nh nhng, ng

k thut, khm i xng v so snh hai bn;

- nh gi c thay i bnh l (tng, gim hoc mt phn x).


TT CC BC NGHA YU CU CN T5. Khm phn x gn c nh u

- T th: NB nm, cng tay gp, hai bn tay ln bng;

- V tr g: NVYT m ngn tay tr hoc ngn ci trn gn c nh u ca NB ri g vo ngn tay m ca mnh;

- Phn x xut hin: gp cng tay.

Xc nh xem phn x gn c nh u bnh thng, tng hay gim




6. Phn x gn c tam u - T th: NB nm nga, cng tay trn bng v vung gc vi cnh tay, bn tay NVYT phn gia cnh tay NB;

- V tr g: gn c tam u, pha trn mm khuu;

- p ng: dui cng tay.

Xc nh xem phn x gn c tam u bnh thng, tng hay gim.




7. Phn x gn c t u i hay phn x gn bnh ch- T th: NB nm nga, chng

cng chn cho hai u gi gp mt gc 45o, NVYT lun cng tay tri xung di kheo chn v hi nng hai chn NB ln;

- V tr g: gn c t u i (khng g thng vo xng bnh ch);

- p ng: NB ht cng chn ra pha trc.

Xc nh phn x gn c t u i bnh thng, tng hay gim NB.




8. Phn x gn gt - T th: NB nm nga, ng i ra

pha ngoi, u gi hi gp, c th NB qu gi, th hai bn chn ra khi ging;

- V tr g: NVYT nm u bn chn NB v hi ko ln pha mu chn, g vo gn gt (gn Achille);

- p ng: mi bn chn p vo tay NVYT.

Xc nh xem phn x gn gt bnh thng, tng hay gim.





Ni khoa

TT CC BC NGHA YU CU CN TB. Khm phn x da, nim mc

9. Khm phn x da bng- T th: NB nm nga, hai chn

chng ln cho c bng mm;- Kch thch da bng bng kim u t, vch nhanh t pha ngoi rn hng vo trong;

- Phn x da bng trn: kch thch pha trn rn (di b sn);

- Phn x da bng gia: kch thch ngang rn;

- Phn x da bng di: kch thch pha di rn, song song vi cung i;

- p ng: c bng co git, nhn rn nh rm li.

Xc nh xem phn x da bng bnh thng, tng hay gim.


k thut, y ln lt t trn xung;

- nh gi ng nhng thay i bnh l.

10. Khm phn x da bu- T th: NB nm nga, i hi

nga ra ngoi;- Kch thch bng kim u t vch

da 1/3 trn ca mt trn i;- p ng: da bu co dm li, tinh

hon i ln pha trn.

Xc nh xem phn x da bu bnh thng, tng hay gim.


k thut, y ln lt t trn xung;

- nh gi ng nhng thay i bnh l.

C. Khm phn x bnh l b thp11. Khm phn x da lng bn chn

- T th: NB nm nga, chn hi doi ra ngoi;

- Kch thch: Du Babinski: dng kim u

t vch dc b ngoi gan bn chn t gt chn v pha ngn chn vng xung pha lng bn chn gn np gp cc ngn chn, khi gn cui nhn mnh hn mt cht;

Du Oppeheim: vut dc theo xng chy ca NB;

Du Gordon: bp mnh vo c cng chn sau ca NB;

Du Schaeffer: bp mnh vo gn Achille.

Xc nh xem phn x da lng bn chn dng tnh hay m tnh.

- NB hp tc tt;- Khm t m, y , ng

k thut (vi bn chn chai dy cn m hoc ngm nc nng cho mm trc khi kch thch);

- nh gi chnh xc phn x m tnh hay dng tnh, phn bit c trng hp phn x dng tnh gi.


TT CC BC NGHA YU CU CN T- p ng: phn x m tnh khi

cc ngn ca bn chn cng cp xung. Phn x dng tnh khi ngn ci dui ra v cc ngn con xe ra nh nan qut.

12. Khm phn x Hoffmann- T th: bn tay NB xp mm

mi;- Kch thch: NVYT cm u ngn

tay gia ca NB bt vi ci; - p ng: du hiu Hoffmann

dng tnh nu mi ln bt, ngn ci v ngn tr ca NB khp li nh gng km.

Xc nh phn x Hoffmann dng tnh hay m tnh.


k thut;- nh gi c phn x

m tnh hay dng tnh.












C - NHI KHOA


C.1 - BNG KIM T VN NUI CON BNG SA M

TT CC BC NGHA YU CU CN TG1- Gp g

1. Cho b m v ngi nh (nu c). Gy thin cm. Tn trng, ph hp vi tui, gii v vn ha vng min.

2. Ngi t vn t gii thiu tn v nhim v ti CSYT.

To s tin tng cho b m v gia nh.

Nu y tn, chc v v nhim v ca mnh.

G2- Gi hi3. Hi tn, tui b m, tn ca tr. To thin cm. R rng, y .4. Hi cc thng tin lin quan n

sc khe, tnh trng ca ngi m, cuc .

Th hin s quan tm v to tm l tt cho b m/ngi nh bt u t vn.

Xc nh c cc vn hin ti ca b m sau sinh c nh hng n vic NCBSM.

5. Hi v nhng kinh nghim NCBSM trong qu kh, nhng kin thc lin quan n NCBSM, v s tit sa hin nay.

S b nh gi v nhng hiu bit ca b m v NCBSM.

- Hi c thng tin v NCBSM nhng ln sinh trc;

- Hi c xem xung sa cha.

G3- Gii thiu6. Li ch ca sa m. Cung cp cho b m

kin thc v li ch ca sa m.

Nu c cc li ch ca sa m (3) v li ch ca sa non (6).

7. Li ch ca nui con bng sa m. Cung cp cho b m nhng kin thc v li ch ca NCBSM vi con v vi m.

Nu c cc li ch ca NCBSM vi con, m v gia nh.

8. Thi gian cho con b- B sm trong vng 1 gi u sau ;- B theo nhu cu ca tr;- B ht v ny ri mi sang v khc;- B hon ton trong 4 thng u;- C th n b sung t thng 4-6;- T thng 6 tr i, phi cho tr n

b sung.

Gip b m bit v thi gian cho con b ph hp.

Gii thiu c y cc ni dung.

G4- Gip 9. Gip b m b tr ng t th khi

cho tr b- u v thn tr nm trn mt ng thng;

Hng dn cch b tr ng khi cho b.

- Ch gip khi b m cn, hy b m t lm cng nhiu cng tt;


Nhi khoa

TT CC BC NGHA YU CU CN T- Mt i din vi v, mi i din

vi nm v;- Tr st vo ngi m;- mng v chn tr.

- m bo b m cm thy thoi mi v th gin.

10. Hng dn b m bc l v cho con b- t cc ngn tay vo thnh ngc

bn i din: ngn tr nng v, ngn ci bn trn v;

- Cc ngn tay khng t qu gn nm v.

Hng dn cch bc l v gip tr d bt v nht.

B m lm c theo hng dn.

11. Hng dn b m cch cho tr ngm bt v- a nm v chm vo mi tr;- i n khi ming tr m rng, a nm v vo ming tr sao cho nm v nm trn trong ming tr; cm ca tr phi t vo v m, mi di hng ra ngoi, qung v pha trn ming tr cn nhiu hn pha di;

- Quan st thy du hiu bt v tt: tr mt chm v su.

Gip tr ngm bt v v mt v tt.

B m nhn bit c tr ngm bt v ng cch.

12. Lun vui v, ng vin an i b m t tin hn v NCBSM.

To tm l thoi mi v t tin hn v NCBSM.

B m hng th, tin tng vo kh nng NCBSM ca mnh.

G5- Gii thch13. Gii thch v chnh sa nhng kin

thc cha ng ca b m v ngi nh v NCBSM.

Gip b m v ngi nh hiu ng hn v NCBSM.

Thi nh nhng, kin tr gp , gii thch, khng t thi bc bi, ch bai, khng p t cc kin ch quan ca ngi t vn.

14. Gii thch r cc du hiu bt thng cn phi thng bo ngay cho NVYT (st, sng, au nm v hay bu v).

B m t nhn bit c du hiu bt thng.

Thng tin r rng, y , chnh xc.

15. Gii thch v hng dn c th cho b m v ngi nh cch duy tr ngun sa m v gi v sinh v hng ngy.

Gip gi v sinh v v duy tr ngun sa m hiu qu nht nui con.

B m v ngi nh bit cch duy tr ngun sa m, b m t thc hin c vic v sinh v hng ngy.


TT CC BC NGHA YU CU CN T16. Gii thch v gip b m t la

chn mt BPTT thch hp.Trnh thai khng nh hng ti vic NCBSM.

B m t la chn c mt BPTT ph hp nht.

17. Tr li v gii thch cc thc mc ca b m v gia nh (nu c).

Gii ta cc vn cn bn khon thc mc ca b m/gia nh v NCBSM.

Gi hi cho b m v ngi nh chia s nhng bn khon thc mc v tr li tha ng cho h.

G6- Gp li18. Khuyn khch b m v ngi nh

gp li bt c khi no c kh khn g lin quan n sa m v NCBSM.

To nim tin cho b m v gia nh khi NCBSM.

B m v gia nh bit c gi gic, a im v ngi gip khi h gp kh khn trong NCBSM.

19. Cung cp ti liu truyn thng v NCBSM v cho tm bit.

Cung cp thm thng tin cho b m v gia nh v NCBSM.

Cc ti liu c cung cp lin quan n NCBSM, d hiu v ph hp vi b m v ngi nh.


Nhi khoa

C.2 - BNG KIM NH GI TUI THAI TR S SINH


1. NVYT cho hi b m v ngi nh, t gii thiu tn v nhim v ti CSYT.

Gip b m v ngi nh yn tm khi tip xc vi NVYT.

Cho hi thn thin, ph hp vi vn ha vng min.

2. Gii thch cho b m v gia nh v mc ch cng vic sp lm v hng dn nhng iu cn thit b m v ngi nh hp tc.

To ra s yn tm cho b m v ngi nh.

B m v ngi nh sn sng hp tc.

3. NVYT mang trang phc theo quy nh, ra tay thng quy, mang gng.

m bo cc quy nh v khng ch nhim khun.

NVYT mang trang phc theo quy nh;Ra tay, mang gng ng quy trnh.

THC HIN

4. Hi ngy u tin k kinh cui ca b m.

Tnh tui thai. Bit c ngy u tin KCC ca b m.

5. nh gi tui thai theo bng nh gi ca Finstrom.

Tnh tui thai. - Thc hin ng v y cc bc theo Bng nh gi tui thai ca Finstrom;

- Kt lun c tui thai ca tr (theo bng nh gi tui thai ca Finstrom).

Kt thc thm khm6. Thng tin cho b m/ngi nh v

kt qu nh gi tui thai, hng dn cc chm sc tip theo cho tr.

m bo quyn c thng tin ca KH.

B m bit c tui thai ca tr v bit c hng chm sc tip theo.

7. Cho tm bit v cm n b m/ngi nh.

KH vui v, tn trng v tin tng NVYT.

Ngn ng v c ch ca NVYT ph hp vi vn ha v phong tc tp qun vng min.

8. NVYT ra tay, ghi kt qu khm vo h s bnh n.

- Khng ch nhim khun;

- m bo cc quy nh h s bnh n.

Ra tay theo quy trnh; Ghi h s bnh n r rng v y .


C.3 - BNG NH GI TUI THAI CA FINSTROM(bng tham chiu)

CC BC IM CCH NH GI IM T

T th123

Nm dui thngNm hai chi di coNm hai chi di co, hai tay co

Nm sp trn tay ngi khm

123

u gp xung thnu ci xung, t chi cou ngng khong 3 giy, hai tay gp, hai chn na co na dui

Nm v 123

L mt chm khng ni trn mt daNhn thy r, s thy, nhng khng ni ln mt daNhn thy r ni trn mt da 2 cm

Mng tay 123

Cha mc n u ngnMc n u ngnMc trm qu u ngn

Sn vnh tai 1234

Mm d bin dng, n bt tr li hoc khngSn mm n bt tr li chmSn vnh tai r, n bt tr li ngaySn cng, n bt tr li tt

Sinh dc ngoi 1234

Cha c tinh hon hoc mi b toTinh hon nm trong ng bnTinh hon nm trong h nang hoc mi ln hi khpBu c np nhn hoc mi ln khp kp

Vch gan bn chn 1234

Khng cC vch ngang 1/3 trn lng bn chnC vch ngang 2/3 trn lng bn chnC vch ngang trn c lng bn chn

Bng im tng ng vi tui thai

IM TUI THAI7 - 8

9 - 10

11 - 14

15 - 17

18 - 20

21 - 22

22 - 24

27 - 28 tun

29 - 30 tun

31 - 32 tun

33 - 34 tun

35 - 36 tun

37 - 39 tun

40 - 42 tun


Nhi khoa

C.4 - BNG KIM HI SC TR S SINH


1. Bn hi sc v cc phng tin hi sc s sinh lun c chun b sn sng trc mi ca :Phng tin ht: dng c ht nht sch: ng ht nht c bu hoc my ht nht s sinh cng cc ng ht catheter 5F hoc 6F, 8F, 10F.Trang b bng v mt n:- Bng hi sc s sinh c van

gim p;- Mt n s sinh sch v c cc c

ph hp cn nng ca tr;- Ngun oxy v ng dn.Trang b t ng ni kh qun (vi tuyn huyn tr ln): n soi thanh qun vi li thng s 0 (non thng) v s 1 ( thng); ng ni kh qun cc c (2,5 - 3,0 - 3,5 - 4,0 mm); catheter TM rn. Thuc: Adrenalin 1, Natribicacbonat 4,2%; dung dch Albumin, Ringer lactat; mui ng trng; nc ct.Dng c khc:- Bn si m;- Bm kim tim 1-5-10-20ml;- ng nghe, ng h bm giy;- Catheter rn;- 3 mnh gc v khun lau kh

mi, ming b;- 3 khn lau kh b, bc b sau

khi lau v cun trn k di vai b;

- Bng dnh, bng cn;- Gng v khun;- Dung dch st khun tay nhanh.

- m bo mi dng c lun y v sn sng dng ngay khi c ch nh hi sc s sinh;

- Gip NVYT thc hin k thut hi sc thun li.

- Bn hi sc sch, kh, m (29-30oC), nh sng v c khn tri sch;

- Trang thit b c chun b y v ng quy cch, sp xp tin s dng;

- Xc nh c nhng dng c no cn thit cho cc mc cn hi sc khc nhau.


TT CC BC NGHA YU CU CN T2. Trong 30 giy u tin sau khi s

thai: lau kh, kch thch h hp, m tr, nh gi ch s Apgar. Nu tr khng khc, khng th hoc th yu


Nhi khoa

TT CC BC NGHA YU CU CN T7. nh gi nhanh tnh trng h hp:

nu tr kh th (rt lm lng ngc, th rn, th nc) hoc khng th: tin hnh h tr h hp ngay.

Sng lc tr thc hin theo di hoc h tr h hp cho ph hp.

Ra quyt nh theo di hoc hi sc tr mt cch chnh xc, kp thi.

H tr h hp8. Kch thch xc gic

- V, bng vo gan bn chn hoc c xt mnh v nhanh dc theo ct sng lng tr khng qu 2 ln;

- Cung cp oxy cho tr qua mt n nu tr t th nhng tm hoc kh th.

Kch thch tr t th v cung cp thm oxy h tr.

- Thao tc khn trng, nh nhng, theo trnh t, ng k thut;

- nh gi chnh xc tnh trng ca tr, quyt nh bc x tr tip theo kp thi.

9. - H hp nhn to nu tr khng t th; hoc tr kh th (rt lm lng ngc, th rn, th nc); hoc tr t th nhng vn tm ti; hoc nhp tim c nhng 60 ln/pht v c xu hng tng ln: chuyn sang bc 17 (theo di tr);

- Nu khng c nhp tim, hoc nhp tim


TT CC BC NGHA YU CU CN Tp tim ngoi lng ngc

11. - Phi hp p tim ng thi vi h hp nhn to theo chu k 3:1 (3 ln n ngc v 1 ln bp bng/thi ngt);

- p tim ng k thut: t u ngn tr v ngn gia (hoc 2 ngn ci) ln xng c tr, ngang ng nm v (ng thi m lng tr nu tr khng nm trn mt phng cng), n su khong 1/3 ng knh trc-sau ca lng ngc, th n ngn hn so vi th th ra, khng nhc u ngn tay ln khi thnh ngc tr trong th th ra.

H tr tun hon, kch thch tim hot ng.

- Thao tc khn trng, nh nhng, ng k thut, phi hp nhp nhng gia 2 NVYT cng tham gia hi sc (1 ngi p tim v 1 ngi thi ngt/bp bng);

- Tr c nh gi nhp tim v h hp ca tr sau mi 30 giy hi sc.

12. nh gi ch s Apgar trong khi hi sc c 5 pht/ln.

Xem hiu qu ca cc phng php hi sc quyt nh thi , phng php iu tr tip theo.

Nhanh v chnh xc.

13. Nu tr t th c: Apgar >7 im: ngng hi sc, tip tc m, cho th oxy n khi tr tr nn hng ho. Theo di st nhp tim v nhp th ca tr, ng thi tin hnh lm rn v thc hin cc chm sc thng quy khc;Hoc chuyn tuyn trn nu: Apgar 6 im, tr t th c nhng cn du hiu cha tt (th chm 60 ln/pht; hoc rt lm lng ngc; hoc th rn; hoc tm ti);Hoc: ngng hi sc nu khng thy c kt qu sau khi hi sc tch cc 20 pht.

- m bo h hp v tun hon ca tr tr li an ton tin hnh cc chm sc thng quy;

- Chuyn tuyn ph hp.

- Xc nh chnh xc tnh trng ca tr sau khi hi sc v ra quyt nh tip theo chnh xc v kp thi;

- B m hoc gia nh c thng tin kp thi v tnh trng tr sau khi hi sc tip tc hp tc vi NVYT.

Dng thuc14. Adrenalin 1/10.000: ch nh nu

ngng tim hoc nhp tim


Nhi khoa

TT CC BC NGHA YU CU CN T15. Natribicacbonat 4,2%: ch nh

nu ngng tim ko di khng p ng vi cc tr liu khc.

m bo thng bng kim toan.

4ml/kg tim tnh mch chm t nht trong 2 pht.

16. B dch (mu ton phn, nc mui sinh l, Ringer lactat): ch nh khi c nghi ng gim th tch tun hon (xanh ti vi nhp tim nhanh; hoc nghi ng mt mu trong ).

m bo khi lng tun hon v cung cp nng lng cho tr.

B dch ng ch nh v ng liu lng, thc hin truyn dch/truyn mu theo ng quy trnh bng kim.

Theo di17. Theo di cht ch nhp th, nhp

tim, mu sc da, nhit ca tr: theo di 1 ln/gi t nht trong 6 gi u sau khi hi sc thnh cng.

Pht hin sm cc bin chng sau hi sc x tr kp thi.

T theo di v hng dn b m/ngi nh cng theo di tr pht hin sm cc du hiu bt thng v nhp th, nhp tim v mu sc da; m bo tr lun c m v kh.

SAU HI SC18. Xc nh nguyn nhn gy ngt v

chuyn chuyn khoa hoc tuyn cao hn tip tc iu tr (nu cn).

iu tr nguyn nhn ngt ti tuyn ph hp.

Tr c iu tr ph hp theo nguyn nhn.

19. Thng bo tnh trng sc khe ca tr cho m hoc ngi nh, hng x tr v chm sc tip theo.

Gip b m v gia nh bit c tnh trng sc khe ca tr v hng x tr/chm sc tip theo.

- Thi n cn, chia s, cm thng;

- B m v gia nh bit tnh trng sc khe ca tr v bit cch phi hp theo di v chm sc tr sau khi hi sc.

20. Thu dn dng c, ra tay, ghi chp h s v phiu chm sc.

Hon thnh th tc h s bnh n.

- ng quy trnh (theo bng kim ring);

- y , r rng, ng quy nh.


C.5 - BNG KIM KHM DA, C, XNG TR EM


CHUN B

1. Dng c - 1 i gng sch;- 1 thc dy;- 1 thc o chiu cao;- 1 thc o lp m di da.Ni khm: C bn khm/ging khm sch s, thong mt.

Dng c v ni khm sn sng tin hnh thm khm thun li.

Chun b dng c v ni khm y v ng quy cch chuyn mn.

2. NVYT mang trang phc theo quy nh, ra tay thng quy, mang gng.

m bo cc quy nh v khng ch nhim khun.

Ra tay, mang gng ng quy trnh.

THC HIN

3. NVYT cho hi b m/ngi nh, t gii thiu tn v nhim v ti CSYT, gii thch cho b m v ngi nh v cng vic sp thc hin v hng dn nhng iu cn thit h hp tc.

Gip b m/ngi nh yn tm khi tip xc vi NVYT.

S dng ngn ng c ch thn thin v ph hp vi vn ha vng min. B m v ngi nh yn tm hp tc.

4. t tr t th thch hp. Thun li cho vic thm khm.

Tr nm hoc c m b, thay i t th tr ph hp vi mi bc thm khm (nu cn).

5. Khm da v phn ph ca da

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